Healthcare Provider Details

I. General information

NPI: 1053989715
Provider Name (Legal Business Name): ZIA INFUSED WELLNESS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4824 MCMAHON BLVD NW STE 113
ALBUQUERQUE NM
87114
US

IV. Provider business mailing address

4824 MCMAHON BLVD NW STE 113
ALBUQUERQUE NM
87114
US

V. Phone/Fax

Practice location:
  • Phone: 505-890-8955
  • Fax: 833-913-2417
Mailing address:
  • Phone: 505-890-8955
  • Fax: 833-913-2417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY L GARCIA
Title or Position: OFFICE MANAGER/BUSINESS PARTNER
Credential:
Phone: 505-890-8955