Green, Stacey D

Green, Stacey D is an individual health care provider with primary practice located at 200 Ucla Medical Plz Ste 120 , Los Angeles CA 90095-1835. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Green, Stacey D can be contacted via phone (310) 206-9260.

Contact Information

Primary practice address
200 Ucla Medical Plz Ste 120 Los Angeles CA 90095-1835
Phone: (310) 206-9260
Fax: (310) 794-1649
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 602389 California

Profile Details

NPI number 1053374397
LBN Legal business name Green, Stacey D
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 8th, 2006
Last updated Jan 2nd, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053374397 NPPES
California MEDICAID RN602389

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