Healthcare Provider Details

I. General information

NPI: 1932046935
Provider Name (Legal Business Name): NICOLE SHEREE GREENE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4877 ALLESANDRO ST
CHINO CA
91710-4052
US

IV. Provider business mailing address

4877 ALLESANDRO ST
CHINO CA
91710-4052
US

V. Phone/Fax

Practice location:
  • Phone: 310-746-6704
  • Fax:
Mailing address:
  • Phone: 310-746-6704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: