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Organization
ROBERT WAGMEISTER M D A MEDICAL CORPORATION
Active
Organization
ROBERT WAGMEISTER M D A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TWILA MARIE BALARA (OFFICE MANAGER)
(310) 828-5626
Entity
Organization
Contact information
Practice address
2001 SANTA MONICA BLVD STE 670W, SANTA MONICA, CA 90404-2185
(310) 828-5626
(310) 828-2826
Mailing address
2001 SANTA MONICA BLVD STE 670W, SANTA MONICA, CA 90404-2185
(310) 828-5626
(310) 828-2826
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G41624
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G416240
—
CA
Enumeration date
12/08/2006
Last updated
10/08/2024
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