Healthcare Provider Details

I. General information

NPI: 1902731177
Provider Name (Legal Business Name): MRS. JENNIFER ANN WOMBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 CAMINO EL ESTERO STE 200
MONTEREY CA
93940-3231
US

IV. Provider business mailing address

605 LOPEZ AVE
SEASIDE CA
93955-5723
US

V. Phone/Fax

Practice location:
  • Phone: 831-521-6014
  • Fax:
Mailing address:
  • Phone: 831-521-6014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number1241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: