Healthcare Provider Details

I. General information

NPI: 1336268499
Provider Name (Legal Business Name): ANGELICA DE LEON RENTERIA N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 MEDICAL CENTER DR E STE 101
CLOVIS CA
93611-6810
US

IV. Provider business mailing address

722 MEDICAL CENTER DR E STE 101
CLOVIS CA
93611-6810
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 559-297-9500
  • Fax: 559-297-9572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP9298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: