MEDICARE: DENISHA WAGNER-PERRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver

General Provider Information

NPI Number	:	1366371973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISHA WAGNER-PERRY

Provider Business Mailing Address
First Line	:	PO BOX 1253
Second Line	:
City	:	SUISUN CITY
State	:	CA
Zip	:	94585-1253
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 GEORGIA ST STE 340A
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94590-5997
Country	:	US
Telephone Number	:	800-481-5540
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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Directions to “ DENISHA WAGNER-PERRY ” Practice Location

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