Doctor Name: | STEPHANIE MARIE WOGOMON |
NPI Number: | 1053673582 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 14320 Palm Dr Desert Hot Springs, CA - 922406874 |
Business Phone Number: | 7607736767 |
Business Fax Number: | |
Mailing Address: | 29429 Wrigleys Cir, LAKE ELSINORE |
State: | CA |
Postal Code: | 925304733 |
Phone Number: | 9093956602 |
Fax Number: | |
NPI Enumeration Date: | 06/11/2012 |
NPI Last Update Date: | 09/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |