Provider Demographics
NPI:1144572025
Name:CUISIA-ZIMMER, CARLA MAE TENORIO (MSN FNP)
Entity Type:Individual
Prefix:MISS
First Name:CARLA MAE
Middle Name:TENORIO
Last Name:CUISIA-ZIMMER
Suffix:
Gender:F
Credentials:MSN FNP
Other - Prefix:
Other - First Name:CARLA MAE
Other - Middle Name:TENORIO
Other - Last Name:CUISIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN FNP
Mailing Address - Street 1:28418 FARRIER DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-4501
Mailing Address - Country:US
Mailing Address - Phone:909-918-9517
Mailing Address - Fax:
Practice Address - Street 1:18300 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4105
Practice Address - Country:US
Practice Address - Phone:818-885-5396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily