Healthcare Provider Details

I. General information

NPI: 1851695340
Provider Name (Legal Business Name): JENNIFER DIANE HEPPNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2010
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2364 TULSA AVE
CLAREMONT CA
91711-1665
US

IV. Provider business mailing address

2364 TULSA AVE
CLAREMONT CA
91711-1665
US

V. Phone/Fax

Practice location:
  • Phone: 951-212-2872
  • Fax:
Mailing address:
  • Phone: 951-212-2872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA118974
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: