Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NP0017X | Pediatric Chiropractor | 32688 | CA |
Y | 175F00000X | Naturopath | 938 | CA |
NPI | 1952743528 |
---|---|
Provider Name | Dr. Jessica Michelle Greene |
First Address | San Diego, CA 92122-1081 |
Second Address | San Diego, CA 92103-1890 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2013 |
Last Update Date | 30/10/2017 |