Provider Demographics
NPI:1588878219
Name:ZUNIGA, JENNIFER ANN (RDH)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:ZUNIGA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 ST FRANCIS DRIVE
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-4457
Mailing Address - Country:US
Mailing Address - Phone:707-548-5080
Mailing Address - Fax:
Practice Address - Street 1:932 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-4457
Practice Address - Country:US
Practice Address - Phone:707-548-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH 22663124Q00000X
CAHAP 326124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist