Provider Demographics
NPI:1497947865
Name:GREEN, MARIE DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE DENISE
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6160 MISSION GORGE RD
Mailing Address - Street 2:SUITE # 400
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3410
Mailing Address - Country:US
Mailing Address - Phone:619-528-4000
Mailing Address - Fax:619-528-4087
Practice Address - Street 1:6160 MISSION GORGE RD
Practice Address - Street 2:SUITE # 400
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-3410
Practice Address - Country:US
Practice Address - Phone:619-528-4000
Practice Address - Fax:619-528-4087
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA101155208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics