Healthcare Provider Details

I. General information

NPI: 1144136706
Provider Name (Legal Business Name): MS. NADINE ANTOINETTE GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6041 CADILLAC AVE
LOS ANGELES CA
90034-1702
US

IV. Provider business mailing address

6041 CADILLAC AVE
LOS ANGELES CA
90034-1702
US

V. Phone/Fax

Practice location:
  • Phone: 323-421-2272
  • Fax: 323-421-2265
Mailing address:
  • Phone: 323-421-2272
  • Fax: 323-421-2265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number141403
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: