Provider Demographics
NPI:1730909938
Name:LABOG, JENIFFER SANTOS (FNP)
Entity type:Individual
Prefix:
First Name:JENIFFER
Middle Name:SANTOS
Last Name:LABOG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JENIFFER
Other - Middle Name:PORCIA
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11585 CAMINITO LA BAR UNIT 15
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-6808
Mailing Address - Country:US
Mailing Address - Phone:858-226-2675
Mailing Address - Fax:
Practice Address - Street 1:1555 PALM AVE STE J2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-1012
Practice Address - Country:US
Practice Address - Phone:619-490-3112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily