Healthcare Provider Details

I. General information

NPI: 1871721043
Provider Name (Legal Business Name): JANELLE P. GREEN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5709 MARKET ST STE I
OAKLAND CA
94608-2811
US

IV. Provider business mailing address

134 HARKNESS AVE
SAN FRANCISCO CA
94134-2122
US

V. Phone/Fax

Practice location:
  • Phone: 415-902-2134
  • Fax: 909-706-3942
Mailing address:
  • Phone: 415-902-2134
  • Fax: 510-444-1966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE5039
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5039
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberE5039
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE5039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: