Healthcare Provider Details

I. General information

NPI: 1366167967
Provider Name (Legal Business Name): MRS. JEANETTE MARIE HEFNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS JEANETTE MARIE ALLEN

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15740 TURNBERRY ST
MORENO VALLEY CA
92555-4903
US

IV. Provider business mailing address

24694 BAY AVE
MORENO VALLEY CA
92553-3809
US

V. Phone/Fax

Practice location:
  • Phone: 951-214-3675
  • Fax:
Mailing address:
  • Phone: 951-288-5735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: