Individual
MRS. KEZZIAH RIZA CASIAS GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2503 SIRINGO LN UNIT A, SANTA FE, NM 87505-5534
(505) 929-1543
Mailing address
2503 SIRINGO LN UNIT A, SANTA FE, NM 87505-5534
(505) 929-1543
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
507287654
NM
Other
Enumeration date
05/10/2016
Last updated
05/10/2016
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