Provider Demographics
NPI:1548616519
Name:CASIAS GREEN, KEZZIAH RIZA
Entity Type:Individual
Prefix:MRS
First Name:KEZZIAH
Middle Name:RIZA
Last Name:CASIAS GREEN
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 1:2503 SIRINGO LN UNIT A
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5534
Mailing Address - Country:US
Mailing Address - Phone:505-929-1543
Mailing Address - Fax:
Practice Address - Street 1:2503 SIRINGO LN UNIT A
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5534
Practice Address - Country:US
Practice Address - Phone:505-929-1543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM507287654373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist