Healthcare Provider Details

I. General information

NPI: 1831710490
Provider Name (Legal Business Name): ZIA COMMUNITY CARES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 GIBSON BLVD BUILDING 11
ALBUQUERQUE NM
87108-8710
US

IV. Provider business mailing address

5400 GIBSON BLVD BOX 18
ALBUQUERQUE NM
87108
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-3113
  • Fax: 505-982-2462
Mailing address:
  • Phone: 505-982-3113
  • Fax: 505-982-2462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MONICA R JARAMILLO
Title or Position: COO
Credential: MSW, MBA
Phone: 505-982-3113