Individual
DIMITRA KOKKALIS WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
324 W PORTAL AVE, SAN FRANCISCO, CA 94127-1412
(415) 731-8080
Mailing address
324 W PORTAL AVE, SAN FRANCISCO, CA 94127-1412
(415) 731-8080
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A172034
CA
Other
Enumeration date
06/04/2014
Last updated
06/04/2014
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