Healthcare Provider Details

I. General information

NPI: 1023756681
Provider Name (Legal Business Name): CHRISTINE WAHIDI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE ZEIDAN PMHNP

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 FROSTBURG CIR
CLAREMONT CA
91711-2977
US

IV. Provider business mailing address

890 VIEWPOINT ST
UPLAND CA
91784-8032
US

V. Phone/Fax

Practice location:
  • Phone: 909-624-7070
  • Fax:
Mailing address:
  • Phone: 909-506-9334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95034430
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95203549
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: