Provider Demographics
NPI:1164758686
Name:GREEN, REBECCA ANN (ND, LAC, MSOM)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ANN
Last Name:GREEN
Suffix:
Gender:F
Credentials:ND, LAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 MIDDLEFIELD RD STE D
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-3000
Mailing Address - Country:US
Mailing Address - Phone:650-485-2758
Mailing Address - Fax:650-397-5360
Practice Address - Street 1:3200 MIDDLEFIELD RD STE D
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-3000
Practice Address - Country:US
Practice Address - Phone:650-485-2758
Practice Address - Fax:650-397-5360
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT61144900175F00000X
CAND-419175F00000X
CAAC14320171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist