Provider Demographics
NPI:1659637064
Name:KEEN, CATHERINE M
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:KEEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:M
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:914 N CANAL ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-5110
Mailing Address - Country:US
Mailing Address - Phone:575-885-4836
Mailing Address - Fax:575-628-0676
Practice Address - Street 1:525 16TH ST
Practice Address - Street 2:
Practice Address - City:SAN MIGUEL
Practice Address - State:CA
Practice Address - Zip Code:93451
Practice Address - Country:US
Practice Address - Phone:805-710-9849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36259167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician