Healthcare Provider Details

I. General information

NPI: 1821701244
Provider Name (Legal Business Name): ZIA HAIDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2022
Last Update Date: 07/21/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N7, CORNER OF ROUTES N12 & ROUTE N7
FORT DEFIANCE AZ
86504
US

IV. Provider business mailing address

2495 S CHESTERFIELD ST
SALT LAKE CITY UT
84119-1501
US

V. Phone/Fax

Practice location:
  • Phone: 928-729-8000
  • Fax:
Mailing address:
  • Phone: 801-859-2009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number44786
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: