Provider Demographics
NPI:1700214442
Name:GREENHALGH, NUBIA
Entity Type:Individual
Prefix:
First Name:NUBIA
Middle Name:
Last Name:GREENHALGH
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:PO BOX 2315
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-2315
Mailing Address - Country:US
Mailing Address - Phone:909-635-7400
Mailing Address - Fax:
Practice Address - Street 1:1028 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4784
Practice Address - Country:US
Practice Address - Phone:626-289-5161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16770124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$OtherDENTAL PROVIDER