Healthcare Provider Details

I. General information

NPI: 1831987965
Provider Name (Legal Business Name): CHARISSA ZIMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1895 ORANGE TREE LN STE 102
REDLANDS CA
92374-0112
US

IV. Provider business mailing address

11234 ANDERSON ST RM 2586A
LOMA LINDA CA
92350-1716
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-7884
  • Fax:
Mailing address:
  • Phone: 909-558-7884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95029980
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: