Healthcare Provider Details

I. General information

NPI: 1497453062
Provider Name (Legal Business Name): ZIA HEALTHCARE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 01/11/2025
Certification Date: 01/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 CENTRAL AVE SW UNIT 401
ALBUQUERQUE NM
87102-3139
US

IV. Provider business mailing address

PO BOX 91902
ALBUQUERQUE NM
87199-1902
US

V. Phone/Fax

Practice location:
  • Phone: 408-687-8206
  • Fax:
Mailing address:
  • Phone:
  • Fax: 505-217-3950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANNE LEDESMA
Title or Position: AUTHORIZED OFFICIAL
Credential: CMPE
Phone: 505-301-5135