Individual
GENESA WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1294 W 6TH ST, SUITE 104, SAN PEDRO, CA 90731-2987
(310) 548-9118
(310) 548-1310
Mailing address
1294 W 6TH ST, SUITE 104, SAN PEDRO, CA 90731-2987
(310) 548-9118
(310) 548-1310
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
G77273
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G772730
—
CA
Enumeration date
08/23/2006
Last updated
12/02/2011
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us