Provider Demographics
NPI:1730317256
Name:NOERENBERG, JENNIFER SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SUSAN
Last Name:NOERENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16955 VIA DEL CAMPO
Mailing Address - Street 2:STE 215
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-7720
Mailing Address - Country:US
Mailing Address - Phone:858-673-6100
Mailing Address - Fax:858-673-6110
Practice Address - Street 1:2185 W CITRACADO PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-4159
Practice Address - Country:US
Practice Address - Phone:422-281-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013022035207L00000X
CAA116348207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$Medicaid