MEDICARE: GREATER GOOD HEALTH PC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner
2	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1285311258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER GOOD HEALTH PC INC

Provider Business Mailing Address
First Line	:	300 CONTINENTAL BLVD STE 635
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-5040
Country	:	US
Telephone Number	:	162-623-2392
Fax Number	:

Provider Business Practice Location Address
First Line	:	1423 38TH ST W UNIT 3
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-7524
Country	:	US
Telephone Number	:	310-658-3775
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	SYLVIA HASTANAN
Credential	:
Telephone Number	:	310-795-8807

Provider Enumeration Date	:	06/30/2023
Last Update Date	:	06/25/2026

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Directions to “GREATER GOOD HEALTH PC INC ” Practice Location

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