Genesa Wagoner is a Pediatrics in San Pedro, California. Genesa Wagoner practices all healthcare services and medical treatments related to Pediatrics. The NPI Number for Genesa Wagoner is 1518074160. The last update date is 2011-12-02.
Genesa Wagoner's current location address is 1294 W 6th St, San Pedro, California. You can contact this provider via phone number 3105489118 and fax number 3105481310. The mailing address for Genesa Wagoner is 1294 W 6th St, San Pedro, California. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Genesa Wagoner |
|---|---|
| Address | 1294 W 6th St, San Pedro, California |
| Phone Number | 3105489118 |
| Fax Number | 3105481310 |
| Sole Proprietor | N |
| Credentials | M.D. |
NPI Number Detail
| NPI Number | 1518074160 |
|---|---|
| Provider Enumeration Date | 2006-08-23 |
| Last Updated Date | 2011-12-02 |
Provider Mailing Address Detail
| Address | 1294 W 6th St |
|---|---|
| City | San Pedro |
| State | California (CA) |
| Post Code | 907312987 |
| Phone Number | 3105489118 |
| Fax Number | 3105481310 |
Provider's Primary Taxonomy Detail
| Speciality | Pediatrics |
|---|---|
| Taxonomy | 208000000X |
| Licence No | G77273 |
|
Definition: A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 00G772730 | CA | -- |
Post Comment/ Review Below
What is the unique provider identifier assigned to Genesa Wagoner?
The Genesa Wagoner has been issued the NPI (National Provider Identifier) 1518074160 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code is a unique identification number for healthcare providers.
Could you provide the complete address where Genesa Wagoner is physically located?
The Genesa Wagoner is situated at the following address: 1294 W 6Th St, San Pedro, CA 907312987.
What is Genesa Wagoner's primary field of medical specialization, and what is the corresponding taxonomy classification code for this area of expertise?
The primary field of medical specialization for Genesa Wagoner is Pediatrics, and the taxonomy classification code that categorizes this area of expertise is 208000000X.
When did Genesa Wagoner receive its 1518074160 assignment?
The Genesa Wagoner was assigned its 1518074160 on 2006-08-23, which is the date when this unique identifier was issued to the organization.
As of what date were the details related to Genesa Wagoner most recently updated or revised?
The information pertaining to Genesa Wagoner, including its address, specialty, and other relevant details, was last updated or revised on 2011-12-02.
NPI Number: 1396748448
Address: 100 Metropolitan Drive Associated Medical Professionals, Liverpool, NY
NPI Number: 1952304982
Address: 310 Lafayette Ave Se Ste 410, Grand Rapids, MI
NPI Number: 1699778829
Address: 1200 Oakleaf Way, Altoona, WI