Healthcare Provider Details

I. General information

NPI: 1639746449
Provider Name (Legal Business Name): ZIA INFUSED WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4824 MCMAHON BLVD NW STE 107
ALBUQUERQUE NM
87114
US

IV. Provider business mailing address

3705 ELLISON DR. NW STE B-1 #114
ALBUQUERQUE NM
87114
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLEE ELIZABETH TAFOYA
Title or Position: CNP/ OWNER
Credential: CNP
Phone: 505-890-8955