Healthcare Provider Details

I. General information

NPI: 1164289344
Provider Name (Legal Business Name): MS. HEATHER JEAN CLIFFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 04/12/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2617 E CHAPMAN AVE STE 306
ORANGE CA
92869-3243
US

IV. Provider business mailing address

14277 GRAYLING DR
EASTVALE CA
92880-1024
US

V. Phone/Fax

Practice location:
  • Phone: 714-997-1920
  • Fax:
Mailing address:
  • Phone: 714-376-3335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95029325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: