Provider Demographics
NPI:1407749229
Name:CEDILLO, ANNETTE J
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:J
Last Name:CEDILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:JEANNETTE
Other - Last Name:NORTHUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8887 PALMETTO AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-4939
Mailing Address - Country:US
Mailing Address - Phone:951-232-2503
Mailing Address - Fax:
Practice Address - Street 1:8887 PALMETTO AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-4939
Practice Address - Country:US
Practice Address - Phone:951-232-2503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X, 385HR2060X, 175T00000X, 251C00000X
CA171M00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No175T00000XOther Service ProvidersPeer Specialist
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician