Healthcare Provider Details

I. General information

NPI: 1407749229
Provider Name (Legal Business Name): ANNETTE J CEDILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNETTE JEANNETTE NORTHUP

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8887 PALMETTO AVE
FONTANA CA
92335-4939
US

IV. Provider business mailing address

8887 PALMETTO AVE
FONTANA CA
92335-4939
US

V. Phone/Fax

Practice location:
  • Phone: 951-232-2503
  • Fax:
Mailing address:
  • Phone: 951-232-2503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: