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General NPI Number Information
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NPI Number | 1518225002
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Entity Type | Organization
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Legal Business Name | CHONA BADAR GREEN M D A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/02/2012
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Last Update Date | 02/09/2024
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Provider Practice Location Address
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Address Line | 23121 PLAZA POINTE DR STE 150
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1468
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Country | US
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Telephone | 949-586-4113
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Fax | 949-837-5002
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Provider Business Mailing Address
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Address Line | 23121 PLAZA POINTE DR STE 150
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1468
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Country | US
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Telephone | 949-586-4113
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Fax | 949-837-5002
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHONA BADAR GREEN
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Credential | M.D.
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Telephone | 949-586-4113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | A53508
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License Number State | CA
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