Healthcare Provider Details

I. General information

NPI: 1689091209
Provider Name (Legal Business Name): TANYA MELISSA ZEID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255A CAMINO DEL PUEBLO
BERNALILLO NM
87004
US

IV. Provider business mailing address

1101 LOPEZ RD SW
ALBUQUERUE NM
87105
US

V. Phone/Fax

Practice location:
  • Phone: 505-867-2356
  • Fax: 505-867-2357
Mailing address:
  • Phone: 505-877-7060
  • Fax: 505-877-7063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: