Provider Demographics
NPI:1225508419
Name:HEBERT, DONNA JO
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JO
Last Name:HEBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 SAN BERNARDINO RD SPC 171
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4942
Mailing Address - Country:US
Mailing Address - Phone:714-603-6763
Mailing Address - Fax:
Practice Address - Street 1:9491 PITTSBURGH AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-9022
Practice Address - Country:US
Practice Address - Phone:909-476-2023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU2014546OtherDRIVERS LICENSE