Healthcare Provider Details

I. General information

NPI: 1477132496
Provider Name (Legal Business Name): GREENE MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SHORELINE HWY BLDG B STE 100-1020
MILL VALLEY CA
94941
US

IV. Provider business mailing address

100 SHORELINE HWY BLDG B STE 100-1020
MILL VALLEY CA
94941
US

V. Phone/Fax

Practice location:
  • Phone: 805-225-4740
  • Fax: 905-367-8210
Mailing address:
  • Phone: 805-225-4740
  • Fax: 905-367-8210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AARON J. GREENE
Title or Position: DIRECTOR/CEO
Credential: MD
Phone: 805-225-4740