Healthcare Provider Details

I. General information

NPI: 1275884868
Provider Name (Legal Business Name): KRISTINA LEE GREENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 12/06/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12898 TOWNE CENTER DR
CERRITOS CA
90703-8546
US

IV. Provider business mailing address

12898 TOWNE CENTER DR
CERRITOS CA
90703-8546
US

V. Phone/Fax

Practice location:
  • Phone: 800-331-1476
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number93525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: