Provider Demographics
NPI:1669767752
Name:FIASEU, KAYCEE (MD)
Entity type:Individual
Prefix:
First Name:KAYCEE
Middle Name:
Last Name:FIASEU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAYCEE
Other - Middle Name:
Other - Last Name:KLOEPPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6320 RIVERSIDE PLAZA LN NW
Mailing Address - Street 2:STE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 COAL AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:505-843-6168
Practice Address - Fax:505-792-1978
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC-183345207V00000X
HI16686207V00000X
NMMD2018-0058207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMMD2018-0058OtherNM MEDICAL BOARD