Healthcare Provider Details

I. General information

NPI: 1538522768
Provider Name (Legal Business Name): CAMBIA SUSSETTE GREEN ROME M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAMBIA SUSSETTE GREEN MD

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 E KASHIAN LN STE 220
FRESNO CA
93701-2211
US

IV. Provider business mailing address

PO BOX 889442
LOS ANGELES CA
90088-9442
US

V. Phone/Fax

Practice location:
  • Phone: 559-453-6600
  • Fax:
Mailing address:
  • Phone: 559-603-7372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number156869
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: