Healthcare Provider Details

I. General information

NPI: 1871402578
Provider Name (Legal Business Name): GREEN TREE HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22110 ROSCOE BLVD STE 104
CANOGA PARK CA
91304
US

IV. Provider business mailing address

22110 ROSCOE BOULEVARD SUITE 104
CANOGA PARK CA
91304
US

V. Phone/Fax

Practice location:
  • Phone: 747-242-1093
  • Fax: 747-242-1096
Mailing address:
  • Phone: 747-242-1093
  • Fax: 747-242-1096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: KARINE ALOYAN
Title or Position: OWNER
Credential: MD
Phone: 646-717-7737