Healthcare Provider Details

I. General information

NPI: 1972252179
Provider Name (Legal Business Name): DANIELLE LOPEZ GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 5TH ST
SANTA ANA CA
92701-4599
US

IV. Provider business mailing address

405 W 5TH ST
SANTA ANA CA
92701-4599
US

V. Phone/Fax

Practice location:
  • Phone: 714-796-0700
  • Fax:
Mailing address:
  • Phone: 657-600-7956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number129169
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: