Healthcare Provider Details

I. General information

NPI: 1912297003
Provider Name (Legal Business Name): AUDREY GREEN-MURPHY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 09/30/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL # SC05
MADERA CA
93636-8762
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL # SC05
MADERA CA
93636-8762
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-3000
  • Fax:
Mailing address:
  • Phone: 559-353-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number19146
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: