Healthcare Provider Details

I. General information

NPI: 1316989494
Provider Name (Legal Business Name): GRETA JONES LIEBELT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRETA H JONES NP

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 FOREST AVE
SAN JOSE CA
95128-1425
US

IV. Provider business mailing address

PO BOX 4419
WOODLAND HILLS CA
91365-4419
US

V. Phone/Fax

Practice location:
  • Phone: 408-947-2500
  • Fax: 818-587-2493
Mailing address:
  • Phone: 888-620-3100
  • Fax: 818-587-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP13218
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: