=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871250019
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER RETANA AUD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2021
-----------------------------------------------------
Last Update Date | 12/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3590 CAMINO DEL RIO N STE 201
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92108-1707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-810-1204
-----------------------------------------------------
Fax | 619-517-3233
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3590 CAMINO DEL RIO N STE 201
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92108-1707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-810-1204
-----------------------------------------------------
Fax | 619-517-3233
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number | AU3669
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AU3669
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------