Healthcare Provider Details

I. General information

NPI: 1750217873
Provider Name (Legal Business Name): GREATER GOOD HEALTH PC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3017 EAGLE DR
AMMON ID
83406-1273
US

IV. Provider business mailing address

300 CONTINENTAL BLVD STE 560
EL SEGUNDO CA
90245-5030
US

V. Phone/Fax

Practice location:
  • Phone: 208-607-3717
  • Fax:
Mailing address:
  • Phone: 626-232-3929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NATALIE PERAZA
Title or Position: OPS MANAGER
Credential:
Phone: 626-232-3929