Healthcare Provider Details

I. General information

NPI: 1114169810
Provider Name (Legal Business Name): KARLA BERMUDEZ WAGNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 4TH ST FL 3
SAN FRANCISCO CA
94143-2350
US

IV. Provider business mailing address

1855 4TH ST FL 3
SAN FRANCISCO CA
94143-2350
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2566
  • Fax: 415-353-2496
Mailing address:
  • Phone: 415-353-2566
  • Fax: 415-353-2496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMT187105
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberQ2102
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberA108445
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: