Provider Demographics
NPI:1336463652
Name:DELA ROSA, EMILY ANGELICA AGITO (FNP-BC)
Entity Type:Individual
Prefix:
First Name:EMILY ANGELICA
Middle Name:AGITO
Last Name:DELA ROSA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8390 HERMOSA AVE APT G
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6928
Mailing Address - Country:US
Mailing Address - Phone:714-803-8960
Mailing Address - Fax:
Practice Address - Street 1:4361 LATHAM ST STE 270
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4332
Practice Address - Country:US
Practice Address - Phone:951-774-0064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP20571363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner