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General NPI Number Information
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NPI Number | 1841441938
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Entity Type | Organization
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Legal Business Name | DAVID GREEN, PH.D. & LOUISE GREEN, PH.D., APC
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 10/07/2008
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Provider Practice Location Address
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Address Line | 5333 MISSION CENTER RD SUITE 354
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City | SAN DIEGO
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State | CA
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Zip | 92108-1302
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Country | US
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Telephone | 619-281-0616
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Fax | 619-528-1263
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Provider Business Mailing Address
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Address Line | 5333 MISSION CENTER RD SUITE 354
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City | SAN DIEGO
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State | CA
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Zip | 92108-1302
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Country | US
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Telephone | 619-281-0616
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Fax | 619-528-1263
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | LOUISE GREEN
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Credential | PH.D.
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Telephone | 619-281-0616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY4696
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY4422
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License Number State | CA
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