Healthcare Provider Details

I. General information

NPI: 1154683977
Provider Name (Legal Business Name): LISA DANIELLE ZIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA DANIELLE HEEG MD

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 W CHARLESTON BLVD STE 504
LAS VEGAS NV
89102-2207
US

IV. Provider business mailing address

2040 W CHARLESTON BLVD STE 504
LAS VEGAS NV
89102-2207
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-6437
  • Fax:
Mailing address:
  • Phone: 702-671-6437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15996
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: