Healthcare Provider Details

I. General information

NPI: 1407676950
Provider Name (Legal Business Name): SCOTT OLIVER GREENE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 W HENDERSON AVE STE 2
PORTERVILLE CA
93257-1490
US

IV. Provider business mailing address

5024 W SANDERS AVE
VISALIA CA
93291-7893
US

V. Phone/Fax

Practice location:
  • Phone: 559-788-1200
  • Fax: 559-749-9772
Mailing address:
  • Phone: 785-404-5470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: