Healthcare Provider Details

I. General information

NPI: 1255744231
Provider Name (Legal Business Name): GLOBAL GREEN MANAGEMENT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N UNION AVE
ROSWELL NM
88201-3267
US

IV. Provider business mailing address

1700 N UNION AVE
ROSWELL NM
88201-3267
US

V. Phone/Fax

Practice location:
  • Phone: 575-624-2121
  • Fax:
Mailing address:
  • Phone: 575-624-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SHALA SOBHANI
Title or Position: CEO
Credential: MD
Phone: 575-624-2121