Healthcare Provider Details

I. General information

NPI: 1760178578
Provider Name (Legal Business Name): ANGELA XI CHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17284 SLOVER AVE STE 205
FONTANA CA
92337-7584
US

IV. Provider business mailing address

17284 SLOVER AVE STE 205
FONTANA CA
92337-7584
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone: 833-574-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95024821
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95024821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: