Healthcare Provider Details

I. General information

NPI: 1114158177
Provider Name (Legal Business Name): JENNIFER SANTORO MARONGIU D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9982 SCRIPPS RANCH BLVD
SAN DIEGO CA
92131-1825
US

IV. Provider business mailing address

9982 SCRIPPS RANCH BLVD
SAN DIEGO CA
92131-1825
US

V. Phone/Fax

Practice location:
  • Phone: 858-566-8510
  • Fax:
Mailing address:
  • Phone: 858-805-5979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number58596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: