Healthcare Provider Details

I. General information

NPI: 1447182530
Provider Name (Legal Business Name): JENNA DE JONGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

5643 COPLEY DR STE 200
SAN DIEGO CA
92111-7903
US

IV. Provider business mailing address

5643 COPLEY DR STE 200
SAN DIEGO CA
92111-7903
US

V. Phone/Fax

Practice location:
  • Phone: 858-727-2525
  • Fax:
Mailing address:
  • Phone: 858-727-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95039850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: