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General NPI Number Information
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NPI Number | 1437562741
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Entity Type | Individual
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Provider Name | TERESA CHA WAGGONER NP-C
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Gender | Female
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Dates
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Enumeration Date | 06/04/2014
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Last Update Date | 06/26/2014
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Provider Practice Location Address
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Address Line | 23772 NEWHALL AVENUE
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City | NEWHALL
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State | CA
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Zip | 91321
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Country | US
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Telephone | 661-291-1777
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Fax | 661-255-1208
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Provider Business Mailing Address
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Address Line | 25115 AVENUE STANFORD, SUITE A-104
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City | VALENCIA
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State | CA
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Zip | 91355
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Country | US
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Telephone | 661-257-2339
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Fax | 661-257-2384
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 23178
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License Number State | CA
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