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General NPI Number Information
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NPI Number | 1346716842
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Entity Type | Individual
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Provider Name | CHARLES ALEXANDRE GREENER PA
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Gender | Male
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Dates
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Enumeration Date | 10/23/2018
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 2141 N HARBOR BLVD STE 35000
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City | FULLERTON
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State | CA
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Zip | 92835-3831
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Country | US
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Telephone | 714-626-8657
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Fax | 714-626-8686
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Provider Business Mailing Address
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Address Line | 6 THE MEWS SOUTH 7TH ST
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City | GENEVA
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State | IL
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Zip | 60134-2629
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Country | US
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Telephone | 224-523-2913
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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