Healthcare Provider Details

I. General information

NPI: 1326131541
Provider Name (Legal Business Name): CHRISTOPHER O'REILLY-GREEN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 FLORIDA AVE #305
MODESTO CA
95350
US

IV. Provider business mailing address

1541 FLORIDA AVE #305
MODESTO CA
95350
US

V. Phone/Fax

Practice location:
  • Phone: 209-576-3832
  • Fax: 209-576-3586
Mailing address:
  • Phone: 209-576-3832
  • Fax: 209-576-3586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberG87639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: