Healthcare Provider Details

I. General information

NPI: 1649233982
Provider Name (Legal Business Name): CAROLYN T GREER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5998 ALCALA PARK
SAN DIEGO CA
92110-2476
US

IV. Provider business mailing address

3503 BAYONNE DR
SAN DIEGO CA
92109-6605
US

V. Phone/Fax

Practice location:
  • Phone: 619-260-2308
  • Fax:
Mailing address:
  • Phone: 858-272-1739
  • Fax: 619-260-2308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: