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General NPI Number Information
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NPI Number | 1679458921
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Entity Type | Individual
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Provider Name | ALEXIS GREEN
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Gender | Female
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 200 EDMONDS RD
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City | REDWOOD CITY
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State | CA
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Zip | 94062
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Country | US
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Telephone | 650-930-7491
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Fax |
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Provider Business Mailing Address
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Address Line | 34077 PASEO PADRE PKWY APT 148
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City | FREMONT
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State | CA
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Zip | 94555-2375
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Country | US
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Telephone | 510-926-9771
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | MPSS-SEOKLB
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License Number State | CA
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