Individual
GAIL MONA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2500 MERCED STREET, SAN LEANDRO, CA 94577-4201
(510) 454-1000
Mailing address
2500 MERCED STREET, SAN LEANDRO, CA 94577-4201
(510) 454-1000
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
G37771
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G377710
—
CA
Enumeration date
11/15/2006
Last updated
07/01/2015
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