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GENESA WAGONER M.D.
NPI 1518074160
Pediatrics in San Pedro, CA

Active since August 23, 2006
1294 W 6TH ST, SUITE 104, SAN PEDRO, CA 90731(310) 548-9118(310) 548-1310 Get Directions Write a Review

NPPES record last updated: December 2, 2011. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Genesa Wagoner M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GENESA WAGONER M.D. (NPI 1518074160) is an individual pediatrics provider in San Pedro, California, licensed in California (G77273) and active in the NPI registry since August 2006.

NPPES Registry Identity

NPI1518074160
Entity TypeIndividualFemale
Primary Taxonomy208000000X
Provider Legal NameGENESA WAGONERCredential: M.D.
Location Address1294 W 6TH ST, SUITE 104San Pedro, CA 90731-2987
Mailing Address1294 W 6th St, Suite 104San Pedro, CA 90731-2987 · (310) 548-9118 · Fax (310) 548-1310
Phone(310) 548-9118
Fax(310) 548-1310
Sole ProprietorNo
Enumeration DateAugust 23, 2006
Last NPPES UpdateDecember 2, 2011
✔ NPI 1518074160 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in CA · G77273
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
1294 W 6TH ST, San Pedro, CA 90731
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Other Identifiers 3

Medicare UPING24462
Medicare ID-Type UnspecifiedWG77273DMedicare Part B Ppin
Medicaid00G772730CA

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BORROWED STAR PSYCHOLOGY GROUP, INC
Psychologist (Clinical)
1294 W 6TH ST, SUITE 105
SAN PEDRO, CA 90731
Los Angeles County (310) 902-6089
DR. GRACE C. PETTERSON MD
Specialist
1294 W 6TH ST, STE#102
SAN PEDRO, CA 90731
Los Angeles County (310) 832-6487
KIMBERLY R WALTON MD INC
Obstetrics & Gynecology (Obstetrics)
1294 W 6TH ST, 201-A
SAN PEDRO, CA 90731
Los Angeles County (310) 831-6515
SAN PEDRO PEDIATRICS MED GRP INC
Pediatrics
1294 W 6TH ST, STE #102
SAN PEDRO, CA 90731
Los Angeles County (310) 832-6487
MICHAEL T O'DONNELL DPT, OCS
Physical Therapist
1294 W 6TH ST, SUITE 101
SAN PEDRO, CA 90731
Los Angeles County (310) 547-1850
MICHAEL CULMER M.D.
Pediatrics
1294 W 6TH ST, SUITE 104
SAN PEDRO, CA 90731
Los Angeles County (321) 054-8911
DR. ANDREW P NOVOM MD
Specialist
1294 W 6TH ST, STE#102
SAN PEDRO, CA 90731
Los Angeles County (310) 832-6487
DR. PRISCILLA S NOVOM MD
Specialist
1294 W 6TH ST, STE#102
SAN PEDRO, CA 90731
Los Angeles County (310) 832-6487

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Genesa Wagoner's NPI number?

The NPI number for Genesa Wagoner is 1518074160. It was assigned to this individual provider in the NPPES registry on August 23, 2006.

Where is Genesa Wagoner located?

Genesa Wagoner practices at 1294 W 6th St Suite 104, San Pedro, CA 90731. The listed phone number is (310) 548-9118.

What is Genesa Wagoner's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

When was this NPI record last updated?

The NPPES record for Genesa Wagoner was last updated on December 2, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.