Healthcare Provider Details

I. General information

NPI: 1487374864
Provider Name (Legal Business Name): RYAN ZIEMBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S DOBSON RD
MESA AZ
85202-4707
US

IV. Provider business mailing address

909 E PLAYA DEL NORTE DR APT 4022
TEMPE AZ
85288-6786
US

V. Phone/Fax

Practice location:
  • Phone: 480-412-3000
  • Fax:
Mailing address:
  • Phone: 925-858-1553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number227458
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: