Healthcare Provider Details

I. General information

NPI: 1003158353
Provider Name (Legal Business Name): ANGELIQUE BABETTE CARTER RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13768 ROSWELL AVE STE 215
CHINO CA
91710-1407
US

IV. Provider business mailing address

PO BOX 2240
WALNUT CA
91788-2240
US

V. Phone/Fax

Practice location:
  • Phone: 909-325-2215
  • Fax: 888-491-0615
Mailing address:
  • Phone: 909-325-2215
  • Fax: 909-325-2215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN487261
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP 22808
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: