Individual
AISHA WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
400 W 30TH ST, LOS ANGELES, CA 90007-3320
(213) 284-3200
Mailing address
400 W 30TH ST, LOS ANGELES, CA 90007-3320
(213) 284-3200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
284465-1
NY
207Q00000X
Family Medicine Physician
Primary
A135827
CA
Other
Enumeration date
06/03/2013
Last updated
03/10/2021
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