Individual
JIMESHA WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
840 N AVENUE 66, LOS ANGELES, CA 90042-1508
(626) 395-7100
Mailing address
840 N AVENUE 66, LOS ANGELES, CA 90042-1508
(626) 395-7100
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
131874
CA
104100000X
Social Worker
—
—
Other
Enumeration date
10/04/2024
Last updated
07/16/2025
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