Healthcare Provider Details

I. General information

NPI: 1053169649
Provider Name (Legal Business Name): ADAYA ROSENTHAL GREEN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 03/06/2025
Certification Date:
Deactivation Date: 01/09/2025
Reactivation Date: 03/06/2025

III. Provider practice location address

ONE BAYLOR PLAZA
HOUSTON TX
77030
US

IV. Provider business mailing address

ESHICOL LEV 60 APARTMENT 17
TEL-AVIV ISRAEL
00000
IL

V. Phone/Fax

Practice location:
  • Phone: 713-798-6078
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: