Provider Demographics
NPI:1508503947
Name:ROGERO, ANGELIA CECILLE (FNP)
Entity Type:Individual
Prefix:
First Name:ANGELIA CECILLE
Middle Name:
Last Name:ROGERO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12350 DEL AMO BLVD APT 1707
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-1719
Mailing Address - Country:US
Mailing Address - Phone:818-493-0267
Mailing Address - Fax:
Practice Address - Street 1:1211 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1748
Practice Address - Country:US
Practice Address - Phone:323-426-9480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF04220567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily