Healthcare Provider Details

I. General information

NPI: 1386321354
Provider Name (Legal Business Name): GREATER GOOD HEALTH PC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 3RD ST NW STE 102&103
GREAT FALLS MT
59404-4111
US

IV. Provider business mailing address

300 CONTINENTAL BLVD STE 635
EL SEGUNDO CA
90245-5040
US

V. Phone/Fax

Practice location:
  • Phone: 310-658-3775
  • Fax:
Mailing address:
  • Phone: 310-658-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SYLVIA HASTANAN
Title or Position: VICE PRESIDENT
Credential:
Phone: 310-795-8807