Healthcare Provider Details

I. General information

NPI: 1861126633
Provider Name (Legal Business Name): JENNA LEIGH GREER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 S SAN VICENTE BLVD # A6600
LOS ANGELES CA
90048-3311
US

IV. Provider business mailing address

4140 W 190TH ST
TORRANCE CA
90504-5513
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-8537
  • Fax:
Mailing address:
  • Phone: 310-248-8055
  • Fax: 310-423-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95021336
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021336
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: