Active NPI
Susan Katali Wagner, PA-C
- Medical Physician Assistant
- Riverside, CA
National Provider Identifier
1457544983
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA16194
- Practice address
- 6926 Brockton Ave
Ste 9
Riverside, CA 92506-3800 - Phone
- (951) 788-0370
- Fax
- (951) 788-0390
- NPI assigned
- Aug 17, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Care Certified Respiratory Therapist | 2278G1100X | RCP19999 | CA | |
| Medical Physician Assistant | 363AM0700X | PA16194 | CA | Primary |
Addresses
Primary practice location
6926 Brockton Ave
Ste 9
Riverside, CA 92506-3800
Mailing address
26610 Kalmia Ave
Moreno Valley, CA 92555-1727
Phone (951) 601-3814
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA16194 | Other | CA | STATE |
| 1034312 | Other | GA | NCCPA |
Other names 1
- Ms. Susan Katali Wagabaza
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RCP19999 | CA | MD | General Care Certified Respiratory Therapist |
| PA16194 | CA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1457544983",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26610 KALMIA AVE",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925551727",
"telephone_number": "951-601-3814"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6926 BROCKTON AVE",
"address_2": "STE 9",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925063800",
"telephone_number": "951-788-0370",
"fax_number": "951-788-0390"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "SUSAN",
"middle_name": "KATALI",
"name_prefix": "Ms.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-17",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "2278G1100X",
"taxonomy_group": "",
"desc": "Respiratory Therapist, Certified, General Care",
"state": "CA",
"license": "RCP19999",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CA",
"license": "PA16194",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE",
"identifier": "PA16194",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCCPA",
"identifier": "1034312",
"state": "GA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SUSAN",
"last_name": "WAGABAZA",
"middle_name": "KATALI",
"prefix": "MS.",
"credential": "PA-C",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.