Provider Demographics
NPI:1699567800
Name:GRIMES, ZACHARY JADEN
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:JADEN
Last Name:GRIMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11051 CARLOW CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-7712
Mailing Address - Country:US
Mailing Address - Phone:909-532-1103
Mailing Address - Fax:
Practice Address - Street 1:11051 CARLOW CT
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-7712
Practice Address - Country:US
Practice Address - Phone:909-532-1103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty