Provider Demographics
NPI:1114450640
Name:MAKAIPO, JANELL
Entity Type:Individual
Prefix:
First Name:JANELL
Middle Name:
Last Name:MAKAIPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 CONVERTIBLE LN
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-1709
Mailing Address - Country:US
Mailing Address - Phone:949-510-0074
Mailing Address - Fax:858-430-9611
Practice Address - Street 1:960 W SAN MARCOS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1100
Practice Address - Country:US
Practice Address - Phone:800-490-9821
Practice Address - Fax:858-430-9611
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44159106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist