Healthcare Provider Details

I. General information

NPI: 1811081383
Provider Name (Legal Business Name): JAYE S VENUTI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12395 EL CAMINO REAL SUITE 312
SAN DIEGO CA
92130
US

IV. Provider business mailing address

12395 EL CAMINO REAL SUITE 312
SAN DIEGO CA
92130
US

V. Phone/Fax

Practice location:
  • Phone: 858-259-0331
  • Fax: 858-259-8729
Mailing address:
  • Phone: 858-259-0331
  • Fax: 858-259-8729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number36025
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: