Healthcare Provider Details

I. General information

NPI: 1043054463
Provider Name (Legal Business Name): ROSANGELICA FELIX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7950 CHERRY AVE STE 108
FONTANA CA
92336-4023
US

IV. Provider business mailing address

345 W D ST
COLTON CA
92324-2216
US

V. Phone/Fax

Practice location:
  • Phone: 909-829-1800
  • Fax:
Mailing address:
  • Phone: 951-322-8062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95037908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: