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General NPI Number Information
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NPI Number | 1366354029
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Entity Type | Organization
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Legal Business Name | GREEN SPORTS MEDICINE INC
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Dates
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Enumeration Date | 09/18/2026
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Last Update Date | 09/18/2026
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Provider Practice Location Address
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Address Line | 7471 N FRESNO ST
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City | FRESNO
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State | CA
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Zip | 93720-2457
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Country | US
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Telephone | 559-813-3005
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Fax |
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Provider Business Mailing Address
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Address Line | 2021 HERNDON AVE STE 201
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City | CLOVIS
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State | CA
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Zip | 93611-6317
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Country | US
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Telephone | 559-387-5230
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Fax |
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Authorized Official
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Title or Position | ADMIN
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Name | SONYA LEAL
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Credential |
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Telephone | 559-387-5230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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