Provider Demographics
NPI:1437751062
Name:BAIZA, KASANDRA (RD)
Entity Type:Individual
Prefix:
First Name:KASANDRA
Middle Name:
Last Name:BAIZA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8102 BROOKGREEN RD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-2202
Mailing Address - Country:US
Mailing Address - Phone:323-424-9857
Mailing Address - Fax:
Practice Address - Street 1:8102 BROOKGREEN RD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-2202
Practice Address - Country:US
Practice Address - Phone:323-424-9857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86276497133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered