Provider Demographics
NPI:1154683977
Name:ZIA, LISA DANIELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:DANIELLE
Last Name:ZIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:DANIELLE
Other - Last Name:HEEG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2040 W CHARLESTON BLVD STE 504
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2207
Mailing Address - Country:US
Mailing Address - Phone:702-671-6437
Mailing Address - Fax:
Practice Address - Street 1:2040 W CHARLESTON BLVD STE 504
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2207
Practice Address - Country:US
Practice Address - Phone:702-671-6437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15996208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics