Provider Demographics
NPI:1194239145
Name:ZIA INTERNAL MEDICINE ASSOCIATES, LLC
Entity type:Organization
Organization Name:ZIA INTERNAL MEDICINE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEHUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAULAT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-391-3968
Mailing Address - Street 1:4001 RODEO RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4830
Mailing Address - Country:US
Mailing Address - Phone:505-780-8381
Mailing Address - Fax:505-467-8521
Practice Address - Street 1:4001 RODEO RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4830
Practice Address - Country:US
Practice Address - Phone:505-780-8381
Practice Address - Fax:505-467-8521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty