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NPI Code Detail

MEDICARE: MS. ANGELIQUE GREEN M.D.

MEDICARE:  MS. ANGELIQUE  GREEN  M.D.
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
1208D00000XGeneral Practice PhysicianG081954CA

General Provider Information

NPI Number : 1427269067
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANGELIQUE GREEN M.D.
Provider Business Mailing Address
First Line : 4230 TERRACE ST
Second Line :
City : OAKLAND
State : CA
Zip : 94611-5128
Country : US
Telephone Number : 510-326-8241
Fax Number :
Provider Business Practice Location Address
First Line : 510 17TH ST
Second Line :
City : OAKLAND
State : CA
Zip : 94612-1553
Country : US
Telephone Number : 510-433-1160
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2007
Last Update Date : 07/08/2007

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Directions to “ MS. ANGELIQUE GREEN M.D.” Practice Location

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