Provider Demographics
NPI:1164421814
Name:GREEN-AMOS, VALERIE (MD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:GREEN-AMOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OCEANGATE STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:562-499-6191
Mailing Address - Fax:562-499-6171
Practice Address - Street 1:200 OCEANGATE STE 100
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4317
Practice Address - Country:US
Practice Address - Phone:562-499-6191
Practice Address - Fax:562-499-6171
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0006360207Q00000X
CAA91907207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A919070Medicaid
CAP01453855OtherRAILROAD MEDICARE - DV5277
CAP01363691OtherRAILROAD MEDICARE-DU4034
CAP01363662OtherRAILROAD MEDICARE-DU4032
DE0001123401Medicaid
CAP01363675OtherRAILROAD MEDICARE- DS9933
CACB205714Medicare PIN
CAH50630Medicare UPIN
DEH50630Medicare UPIN
DE0001123401Medicaid
CAP01363675OtherRAILROAD MEDICARE- DS9933
CACA117317Medicare PIN
CAP01363662OtherRAILROAD MEDICARE-DU4032
CAP01363691OtherRAILROAD MEDICARE-DU4034
CACA122519Medicare PIN