Provider Demographics
NPI:1750390423
Name:DOMBROWER, JAN (MS)
Entity type:Individual
Prefix:MS
First Name:JAN
Middle Name:
Last Name:DOMBROWER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 B ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-2917
Mailing Address - Country:US
Mailing Address - Phone:510-537-8630
Mailing Address - Fax:925-462-3367
Practice Address - Street 1:1345 B ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-2917
Practice Address - Country:US
Practice Address - Phone:510-537-8630
Practice Address - Fax:925-462-3367
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC12585106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist