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General NPI Number Information
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NPI Number | 1982316824
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Entity Type | Organization
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Legal Business Name | GREENLEAF NEURO TECHNOLOGY, INC
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Dates
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Enumeration Date | 12/22/2022
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Last Update Date | 12/22/2022
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Provider Practice Location Address
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Address Line | 1101 GROVE LN
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-5644
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Country | US
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Telephone | 888-851-3677
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Fax | 888-851-3671
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Provider Business Mailing Address
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Address Line | 1101 GROVE LN
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-5644
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Country | US
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Telephone | 888-851-3677
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Fax | 888-851-3671
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Authorized Official
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Title or Position | BILLING ADMINISTRATOR
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Name | AISHA BAILEY
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Credential |
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Telephone | 914-426-3760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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