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General NPI Number Information
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NPI Number | 1336463652
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Entity Type | Individual
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Provider Name | EMILY ANGELICA AGITO DELA ROSA FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/15/2010
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Last Update Date | 01/22/2019
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Provider Practice Location Address
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Address Line | 4361 LATHAM ST STE 270
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City | RIVERSIDE
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State | CA
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Zip | 92501-4332
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Country | US
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Telephone | 951-774-0064
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Fax |
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Provider Business Mailing Address
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Address Line | 8390 HERMOSA AVE APT G
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-6928
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Country | US
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Telephone | 714-803-8960
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP20571
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License Number State | CA
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