Healthcare Provider Details

I. General information

NPI: 1346058047
Provider Name (Legal Business Name): ALICIA NICOLE GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 HOPYARD RD STE 100
PLEASANTON CA
94588-7101
US

IV. Provider business mailing address

3218 MAY RD
RICHMOND CA
94803-2432
US

V. Phone/Fax

Practice location:
  • Phone: 424-522-8392
  • Fax:
Mailing address:
  • Phone: 510-621-9105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: