Healthcare Provider Details

I. General information

NPI: 1699643999
Provider Name (Legal Business Name): JACINTA DOREA HEFLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 SHERWOOD DR 1044 SHERWOOD DR
DAYTON OH
45406-5735
US

IV. Provider business mailing address

1044 SHERWOOD DR 1044 SHERWOOD DR
DAYTON OH
45406-5735
US

V. Phone/Fax

Practice location:
  • Phone: 937-422-8223
  • Fax:
Mailing address:
  • Phone: 937-422-8223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: