Individual
MS. ANDREA THERESA WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4367 MOWRY AVE, FREMONT, CA 94538-1257
(510) 794-6105
Mailing address
4367 MOWRY AVE, FREMONT, CA 94538-1257
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
04/09/2007
Last updated
07/08/2007
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