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NPI Code Detail

MEDICARE: PATRICIA GREEN

MEDICARE: PATRICIA GREEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1194377135
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA GREEN
Provider Business Mailing Address
First Line : 1624 SANTA CLARA DR
Second Line :
City : ROSEVILLE
State : CA
Zip : 95661-3554
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1624 SANTA CLARA DR
Second Line :
City : ROSEVILLE
State : CA
Zip : 95661-3554
Country : US
Telephone Number : 916-779-2455
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2019
Last Update Date : 11/18/2020

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Directions to “ PATRICIA GREEN ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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