Healthcare Provider Details

I. General information

NPI: 1770493223
Provider Name (Legal Business Name): ANGEL ANDREW PENAFIEL NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PEPPER AVE
COLTON CA
92324-1801
US

IV. Provider business mailing address

400 N PEPPER AVE
COLTON CA
92324-1801
US

V. Phone/Fax

Practice location:
  • Phone: 909-580-6210
  • Fax: 909-580-1363
Mailing address:
  • Phone: 909-580-6210
  • Fax: 909-580-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95039632
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: