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Individual

LISA WAGGONER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RVT

Contact information

Practice address
829 W 4TH AVE, CHICO, CA 95926-3601
(530) 521-3617
Mailing address
829 W 4TH AVE, CHICO, CA 95926-3601
(530) 521-3617

Taxonomy

Speciality
Code
Description
License number
State
374700000X
Technician
Primary
TEC5824
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
B9082355
CA
Enumeration date
01/12/2022
Last updated
01/12/2022
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