Provider Demographics
NPI:1104222090
Name:VICTOR L GREENER, DPM, INC
Entity Type:Organization
Organization Name:VICTOR L GREENER, DPM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:GREENER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:559-674-3338
Mailing Address - Street 1:300 E ALMOND AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-5653
Mailing Address - Country:US
Mailing Address - Phone:559-674-3338
Mailing Address - Fax:559-674-1149
Practice Address - Street 1:300 E ALMOND AVE STE 105
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5653
Practice Address - Country:US
Practice Address - Phone:559-674-3338
Practice Address - Fax:559-674-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3225261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1427236538Medicare NSC
CAT11587Medicare UPIN