Individual provider Active NPI

Mercedes Fajardo Wagner, PHARM.D.

  • Pharmacist
  • Laguna Niguel, CA
National Provider Identifier
1831516509
Registry record updated Mar 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
42401 Issued in CA
Practice address
23631 Dane CT
Laguna Niguel, CA 92677-4618
Phone
(949) 249-9665
Fax
(949) 249-9665
NPI assigned
Mar 19, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 19, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 42401 CA Primary

Addresses

Primary practice location

23631 Dane CT
Laguna Niguel, CA 92677-4618

Mailing address

23631 Dane CT
Laguna Niguel, CA 92677-4618
Phone (949) 249-9665

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
42401CAMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395187200000",
    "number": "1831516509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23631 DANE CT",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "926774618",
            "telephone_number": "949-249-9665",
            "fax_number": "949-149-9665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23631 DANE CT",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "926774618",
            "telephone_number": "949-249-9665",
            "fax_number": "949-249-9665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MERCEDES",
        "middle_name": "FAJARDO",
        "name_prefix": "Mrs.",
        "credential": "PHARM.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-03-19",
        "last_updated": "2014-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "42401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laguna Niguel, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.