Healthcare Provider Details

I. General information

NPI: 1962324558
Provider Name (Legal Business Name): MS. SHEILA DENISE GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N WILLOWBROOK AVE UNIT R-3
COMPTON CA
90220-2464
US

IV. Provider business mailing address

500 N WILLOWBROOK AVE UNIT R-3
COMPTON CA
90220-2464
US

V. Phone/Fax

Practice location:
  • Phone: 323-972-2114
  • Fax:
Mailing address:
  • Phone: 323-972-2114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95040541
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: