Provider Demographics
NPI:1174244750
Name:ZIA, BANEEN
Entity type:Individual
Prefix:
First Name:BANEEN
Middle Name:
Last Name:ZIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CONGRESS ST STE 103
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3027
Mailing Address - Country:US
Mailing Address - Phone:626-796-6164
Mailing Address - Fax:626-796-0883
Practice Address - Street 1:10 CONGRESS ST STE 103
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3027
Practice Address - Country:US
Practice Address - Phone:626-796-6164
Practice Address - Fax:626-796-0883
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17480363A00000X
CAPA66187363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant