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General NPI Number Information
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NPI Number | 1366167967
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Entity Type | Individual
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Provider Name | MRS. JEANETTE MARIE HEFNER
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Gender | Female
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Dates
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Enumeration Date | 10/05/2022
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 15740 TURNBERRY ST
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City | MORENO VALLEY
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State | CA
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Zip | 92555-4903
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Country | US
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Telephone | 951-214-3675
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Fax |
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Provider Business Mailing Address
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Address Line | 24694 BAY AVE
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City | MORENO VALLEY
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State | CA
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Zip | 92553-3809
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Country | US
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Telephone | 951-288-5735
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 19599
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License Number State | CA
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