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General NPI Number Information
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NPI Number | 1497464804
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Entity Type | Individual
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Provider Name | BRANDON PHILLIP GREEN
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Gender | Male
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Dates
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Enumeration Date | 11/15/2022
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 17906 PIONEER BLVD UNIT 101-102
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City | ARTESIA
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State | CA
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Zip | 90701-3972
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Country | US
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Telephone | 562-865-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 28520 WOOD CANYON DR APT 67
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City | ALISO VIEJO
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State | CA
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Zip | 92656-5270
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Country | US
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Telephone | 510-828-7183
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 303159
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License Number State | CA
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