MS. SUSAN KATALI WAGNER


Address: 6926 Brockton Ave, Ste 9, Riverside, CA 92506-3800
Phone: 9517880370

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).

Provider Overview

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

Taxonomy

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

Other Provider Identifier

State Issuer Identifier Type Code
CA STATE PA16194 01
CA DEA MW0836607 01
GA NCCPA 1034312 01

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1508089053 Susan Wagner Psychologist 223 Katonah Ave Ste Ef, Katonah, NY 10536-2146 2007-04-11
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1679963482 Susan Anglin Wagner Counselor 205 N Monroe St, Media, PA 19063-3052 2015-02-01

Office Location

Street Address 6926 BROCKTON AVE
STE 9
City RIVERSIDE
State CA
Zip Code 92506-3800

Providers in the same location

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
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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 363AM0700X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Medical

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

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
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Competitor

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City RIVERSIDE
Zip Code 92506

Improve Information

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Dataset Information

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.

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