Provider Demographics
NPI:1467141002
Name:GREEN, LESLIE EILEEN
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:EILEEN
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 CESSNA CT APT SUITE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-4804
Mailing Address - Country:US
Mailing Address - Phone:408-528-5373
Mailing Address - Fax:
Practice Address - Street 1:6315 CESSNA CT APT SUITE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-4804
Practice Address - Country:US
Practice Address - Phone:408-528-5373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula