Healthcare Provider Details

I. General information

NPI: 1679295422
Provider Name (Legal Business Name): MICHELLE ANGELINA DE LEON-RODRIGUEZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 E HERNDON AVE STE 201
FRESNO CA
93720-2824
US

IV. Provider business mailing address

7370 N PALM AVE STE 101
FRESNO CA
93711-5782
US

V. Phone/Fax

Practice location:
  • Phone: 559-437-7311
  • Fax: 559-437-7152
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95022057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: