Individual
JONATHAN WANAGAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD PHD
Contact information
Practice address
200 MEDICAL PLZ, SUITE 420, LOS ANGELES, CA 90095-0001
(310) 206-2583
(310) 794-2199
Mailing address
5767 W CENTURY BLVD, 200, LOS ANGELES, CA 90045-5631
(310) 206-7272
(310) 794-2113
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
A107495
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831204627
—
CA
Enumeration date
08/20/2006
Last updated
02/07/2011
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