Healthcare Provider Details

I. General information

NPI: 1871250019
Provider Name (Legal Business Name): JENNIFER RETANA AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3590 CAMINO DEL RIO N STE 201
SAN DIEGO CA
92108-1707
US

IV. Provider business mailing address

3590 CAMINO DEL RIO N STE 201
SAN DIEGO CA
92108-1707
US

V. Phone/Fax

Practice location:
  • Phone: 619-810-1204
  • Fax: 619-517-3233
Mailing address:
  • Phone: 619-810-1204
  • Fax: 619-517-3233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU3669
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU3669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: