Healthcare Provider Details

I. General information

NPI: 1992327811
Provider Name (Legal Business Name): ZIA FOOT & ANKLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4151 CAMINO COYOTE
LAS CRUCES NM
88011-7096
US

IV. Provider business mailing address

4208 CANTERBURY DR
EL PASO TX
79902-1352
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-0484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE GONZALEZ
Title or Position: PODIATRIST/PRESIDENT
Credential: DPM
Phone: 915-422-3776