Healthcare Provider Details

I. General information

NPI: 1205221694
Provider Name (Legal Business Name): ALEJANDRA GREEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEJANDRA GUTIERREZ

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17909 SOLEDAD CANYON RD STE 100
CANYON COUNTRY CA
91387-3210
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 661-367-3500
  • Fax:
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2007137
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA151120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: