Provider Demographics
NPI:1558572131
Name:WAGMAN, JAN OANE (PHD, MFT)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:OANE
Last Name:WAGMAN
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 ENCINITAS BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4352
Mailing Address - Country:US
Mailing Address - Phone:760-479-2420
Mailing Address - Fax:760-479-2454
Practice Address - Street 1:2236 ENCINITAS BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4352
Practice Address - Country:US
Practice Address - Phone:760-479-2420
Practice Address - Fax:760-479-2454
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36292106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist