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General NPI Number Information
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NPI Number | 1710086384
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Entity Type | Individual
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Provider Name | JOHN M GREENE MD
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Gender | Male
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 08/02/2019
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Provider Practice Location Address
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Address Line | 634 N SANTA CRUZ AVE, ST 210
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City | LOS GATOS
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State | CA
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Zip | 95030
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Country | US
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Telephone | 408-871-1418
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Fax | 408-354-1401
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Provider Business Mailing Address
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Address Line | 15466 LOS GATOS BLVD. ST 109-206
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City | LOS GATOS
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State | CA
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Zip | 95032
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Country | US
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Telephone | 408-871-1418
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Fax | 408-871-1419
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A69431
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License Number State | CA
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