Provider Demographics
NPI:1659437416
Name:FORESTER, ZAIDA DENISE ANNE (RN)
Entity Type:Individual
Prefix:
First Name:ZAIDA DENISE
Middle Name:ANNE
Last Name:FORESTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ZAIDA DENISE
Other - Middle Name:ANNE
Other - Last Name:RODRIGUEZ-DUE-JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CS
Mailing Address - Street 1:1402 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-4954
Mailing Address - Country:US
Mailing Address - Phone:714-831-9090
Mailing Address - Fax:
Practice Address - Street 1:1402 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-4954
Practice Address - Country:US
Practice Address - Phone:714-831-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41385 PHN163WC1500X
CACNS400364SP0809X, 364SP0809X, 364SP0809X
CARN379623163W00000X
VA0015000055364SP0809X
TNAPN0000010666364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
202742700OtherUS DEPT OF LABOR
VA005510775Medicaid
461123OtherTRIGON
VA005510775Medicaid