Individual provider Active NPI

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  • Psychiatric/Mental Health Nurse Practitioner
  • Fontana, CA
National Provider Identifier
1679119127
Registry record updated Jun 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95026637 Issued in CA
Practice address
14050 Cherry Ave Ste R
Fontana, CA 92337-2002
Phone
(310) 935-0327
Fax
(310) 564-1171
NPI assigned
Nov 20, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Registered Nurse 163WP0808X 95127232 CA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95026637 CA Primary

Addresses

Primary practice location

14050 Cherry Ave Ste R
Fontana, CA 92337-2002

Mailing address

14050 Cherry Ave Ste R
Fontana, CA 92337-2002
Phone (310) 935-0327

Other practice location 1

100 W California Blvd
Pasadena, CA 91105-3010
Phone (626) 397-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250507002901 CA Practitioner - Nurse Practitioner 4880111426 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95127232CAMDPsychiatric/Mental Health Registered Nurse
95026637CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PC Psychiatric/Mental Health CurrentSince Mar 28, 2025 Accepting new patients

Locations

99 Almaden Blvd
Ste 600
San Jose, CA 95113
Phone (408) 402-4385

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750291200000",
    "number": "1679119127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14050 CHERRY AVE STE R",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923372002",
            "telephone_number": "310-935-0327",
            "fax_number": "310-564-1171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14050 CHERRY AVE STE R",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923372002",
            "telephone_number": "310-935-0327",
            "fax_number": "310-564-1171"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 W California Blvd",
            "address_purpose": "LOCATION",
            "city": "Pasadena",
            "state": "CA",
            "postal_code": "911053010",
            "country_code": "US",
            "telephone_number": "626-397-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WELCOME",
        "first_name": "NEGRESHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-20",
        "last_updated": "2025-06-19",
        "certification_date": "2025-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95127232",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95026637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fontana, CA

Sources for this page

Verify at the official NPI Registry.