MS. SUSAN KATALI WAGNER (NPI# 1457544983) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1457544983 |
Entity Type | Individual |
Full Name | MS. SUSAN KATALI WAGNER |
Other Name | MS. SUSAN KATALI WAGABAZA |
Credential | PA-C |
Practice Address |
6926 Brockton Ave Ste 9 Riverside CA 92506-3800 |
Mailing Address |
26610 Kalmia Ave Moreno Valley CA 92555-1727 |
Practice Telephone | 9517880370 |
Practice Fax Number | 9517880390 |
Mailing Telephone | 9516013814 |
Enumeration Date | 2007-08-17 |
Last Update Date | 2013-01-11 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 2278G1100X |
Respiratory Therapist, Certified Specialization: General Care |
RCP19999 | CA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA16194 | CA | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
CA | STATE | PA16194 | 01 |
CA | DEA | MW0836607 | 01 |
GA | NCCPA | 1034312 | 01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1811514722 | Susan Maxine Wagner | Nurse Practitioner | 103 Hilton Cir, Enterprise, AL 36330-7815 | 2020-06-26 |
1154672400 | Susan Wagner | Case Manager/Care Coordinator | 12 Lancaster Rd, Island Park, NY 11558-2136 | 2012-09-26 |
1134420185 | Susan Carol Wagner | Social Worker | 1108 Dithridge Dr, Johnstown, PA 15905-1503 | 2010-11-08 |
1467776781 | Susan Elizabeth Wagner | Marriage & Family Therapist | 79 Encinal Way, Ventura, CA 93001-3317 | 2010-03-15 |
1275768558 | Susan J Wagner | Community Health Worker | 278 John Tuttle Rd, New Kingston, NY 12459 | 2009-05-15 |
1437353976 | Susan Folmar Wagner | Counselor | 1040 Allegheny Ave Sw, Ocean Crest School, Bandon, OR 97411-9034 | 2007-06-11 |
1508089053 | Susan Wagner | Psychologist | 223 Katonah Ave Ste Ef, Katonah, NY 10536-2146 | 2007-04-11 |
1144337635 | Susan M Wagner | Physical Therapist | 85 Pleasant Dr, Hastings, MN 55033-1648 | 2006-08-23 |
1346695301 | Susan Rae Wagner | Nurse Practitioner | 142 Highland Dr, Lebanon, VA 24266-4636 | 2016-04-27 |
1679963482 | Susan Anglin Wagner | Counselor | 205 N Monroe St, Media, PA 19063-3052 | 2015-02-01 |
Street Address |
6926 BROCKTON AVE STE 9 |
City | RIVERSIDE |
State | CA |
Zip Code | 92506-3800 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1386611242 | Herman A Carstens | Obstetrics & Gynecology | 6926 Brockton Ave, Suite 7, Riverside, CA 92506-3804 | 2006-02-28 |
1730723677 | Kathryn Rachel Porter | Pediatrics | 6926 Brockton Ave, Riverside, CA 92506-3800 | 2019-11-04 |
1780076034 | Negeen Zareh, D.m.d., Inc., A Professional Corporation | Dentist | 6926 Brockton Ave, Suite 3, Riverside, CA 92506-3800 | 2015-02-24 |
1184028557 | Herman A Carstens Md Clinic of Obstetrics and Gynecology P C | Obstetrics & Gynecology | 6926 Brockton Ave, Suite 7, Riverside, CA 92506-3800 | 2014-10-14 |
1831510353 | Lauren Seastrom Hunt | Nurse Practitioner | 6926 Brockton Ave, Suite 6, Riverside, CA 92506-3804 | 2013-12-31 |
1841534302 | Hubert C. Watkins, M.d., Inc. | Clinic/Center | 6926 Brockton Ave, Suite 10, Riverside, CA 92506-3800 | 2012-11-21 |
1346431145 | Edilberto Lumelay Agas Jr. | Pediatrics | 6926 Brockton Ave, Suite 6, Riverside, CA 92506-3800 | 2007-08-06 |
1811103823 | Naresh Kumar Sharma | Orthopaedic Surgery | 6926 Brockton Ave, Suite 11, Riverside, CA 92506 | 2007-05-15 |
1780709899 | Tracy Scott Maccallum | Specialist | 6926 Brockton Ave, #8, Riverside, CA 92506-3804 | 2007-03-20 |
1750419438 | Mission Pediatrics, Inc. | Pediatrics | 6926 Brockton Ave, Ste 6, Riverside, CA 92506-3804 | 2007-03-02 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1902405715 | Riverside Primary Care Clinic, Joanna Ayala Md | Clinic/Center | 3978 Merrill Ave, Riverside, CA 92506 | 2020-10-22 |
1336747005 | Beatriz Arredondo | Behavioral Analyst | 6117 Brockton Avenue Ste. 202, Riverside, CA 92506 | 2020-10-14 |
1740756782 | Priscilla Marie Rodriguez | Social Worker | 3742 Tibbets St Suite 201, Riverside, CA 92506 | 2018-10-17 |
1922593946 | Prevail Health Solutions, LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 7450 Chateau Ridge Ln, Riverside, CA 92506 | 2018-06-22 |
1831691880 | Mckinley Children's Center | Community/Behavioral Health | 6700 Indiana Avenue, Suite 280, Riverside, CA 92506 | 2018-03-06 |
1720590946 | Leticia Dilworth | Behavioral Analyst | 3610 Central Ave Ste 46, Riverside, CA 92506 | 2017-10-27 |
1548771736 | Usa Biosciences LLC | Clinical Medical Laboratory | 5750 Division St Ste 109, Riverside, CA 92506 | 2017-10-16 |
1922542273 | Yazmar Sevilla-perez | Physical Therapist | 6852 Brockton Ave., Suite 212, Riverside, CA 92506 | 2016-12-06 |
1821547605 | Pathway To Healing, Marriage and Family Therapy, Inc. | Marriage & Family Therapist | 5790 Magnolia Ave., Ste 202, Rm F, Riverside, CA 92506 | 2016-09-22 |
1952857542 | Kramer and Nguyen Dental Corporation | Dentist | 3602 Riverside Plaza Dr, Ste 101, Riverside, CA 92506 | 2016-09-01 |
Find all providers in zip 92506 |
Taxonomy Code | 363AM0700X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Medical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1487136123 | Amy Cortez | Physician Assistant | 3838 Sherman Dr Ste 203, Riverside, CA 92503-4060 | 2018-08-29 |
1003265117 | Travis William Cruz | Physician Assistant | 9525 Los Amigos Court, Riverside, CA 92508 | 2016-06-09 |
1619325875 | Johnny Morales | Physician Assistant | 9065 Limecrest Dr, Riverside, CA 92508-6418 | 2016-05-28 |
1003273707 | Kevin Morris | Physician Assistant | 7101 Magnolia Ave Ste A, Riverside, CA 92504-3843 | 2016-01-26 |
1386014132 | Tariq Parwani | Physician Assistant | 7450 Northrop Dr, #261, Riverside, CA 92508-5002 | 2015-10-05 |
1962808477 | Erika Lee Amthor | Physician Assistant | 7095 Indiana Ave Ste 210, Riverside, CA 92506-4159 | 2014-11-11 |
1821493230 | Jean Huynh | Physician Assistant | 11725 State Ave., Suite 100, Riverside, CA 92505 | 2014-10-28 |
1831505080 | Samantha Miller | Physician Assistant | 4646 Brockton Ave Ste 101, Riverside, CA 92506-0103 | 2014-07-09 |
1679870695 | Maria E. Lopez | Physician Assistant | 6200 Van Buren Blvd, Riverside, CA 92503-2098 | 2011-02-28 |
1811207632 | Bekele T Haimanot | Physician Assistant | 9528 Los Coches Court, Riverside, CA 92508 | 2010-10-14 |
Find all providers in RIVERSIDE |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.