Provider Demographics
NPI:1497453062
Name:ZIA HEALTHCARE GROUP, LLC
Entity Type:Organization
Organization Name:ZIA HEALTHCARE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDESMA
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:505-301-5135
Mailing Address - Street 1:PO BOX 91902
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-1902
Mailing Address - Country:US
Mailing Address - Phone:408-687-8206
Mailing Address - Fax:505-217-3950
Practice Address - Street 1:524 CENTRAL AVE SW UNIT 401
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3139
Practice Address - Country:US
Practice Address - Phone:408-687-8206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty