Healthcare Provider Details

I. General information

NPI: 1760318489
Provider Name (Legal Business Name): PAOLA ROSITO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9695 BASE LINE RD
RANCHO CUCAMONGA CA
91730-1314
US

IV. Provider business mailing address

11370 TAMARISK AVE
HESPERIA CA
92345-4539
US

V. Phone/Fax

Practice location:
  • Phone: 909-520-8789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95193236
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: