Provider Demographics
NPI:1386536530
Name:DE LA ROCA, HAILEY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:DE LA ROCA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 PRINGLE CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-8469
Mailing Address - Country:US
Mailing Address - Phone:209-620-0809
Mailing Address - Fax:
Practice Address - Street 1:500 S ANAHEIM HILLS RD STE 242
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4760
Practice Address - Country:US
Practice Address - Phone:714-200-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034730363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily