MEDICARE: GREEN CROSS MED NET 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	208D00000X	General Practice Physician		CA

General Provider Information

NPI Number	:	1851609176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN CROSS MED NET INC

Provider Business Mailing Address
First Line	:	5832 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-3712
Country	:	US
Telephone Number	:	323-750-7354
Fax Number	:	323-750-7446

Provider Business Practice Location Address
First Line	:	5832 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-3712
Country	:	US
Telephone Number	:	323-750-7354
Fax Number	:	323-750-7446

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MR. NABIL KHALIL
Credential	:	MD
Telephone Number	:	323-750-7354

Provider Enumeration Date	:	09/21/2010
Last Update Date	:	09/21/2010

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Directions to “GREEN CROSS MED NET INC ” Practice Location

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