Healthcare Provider Details

I. General information

NPI: 1336091115
Provider Name (Legal Business Name): ESTHER GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ESTHER LILA HAREB

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10431 COMMERCE ST
REDLANDS CA
92374-0110
US

IV. Provider business mailing address

2912 W CANYON AVE
SAN DIEGO CA
92123-4650
US

V. Phone/Fax

Practice location:
  • Phone: 909-735-7654
  • Fax:
Mailing address:
  • Phone: 805-448-2708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: