Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Genesa Wagoner, MD

Individual provider Pediatrics Physician · NPI 1518074160

Genesa Wagoner, MD is a Pediatrics Physician in San Pedro, California. Licensed in California. Registered with an NPI since 2006.

Licensed in
CA
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1294 W 6th St Ste 104
San Pedro, CA 90731-2987
Phone: (310) 548-9118
Fax: (310) 548-1310
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Specialties & licences

Pediatrics Physician (primary) Taxonomy 208000000X · Licence G77273 (CA)

Record details

NPI number1518074160
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedAugust 23, 2006
Last updated in NPPESDecember 2, 2011
Mailing address1294 W 6th St, Suite 104, San Pedro, CA 90731-2987

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