Provider Demographics
NPI:1790397750
Name:GREEN, TRESCHANNA
Entity Type:Individual
Prefix:
First Name:TRESCHANNA
Middle Name:
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 1:921 LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2210
Mailing Address - Country:US
Mailing Address - Phone:415-664-1414
Mailing Address - Fax:415-664-7741
Practice Address - Street 1:921 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-2210
Practice Address - Country:US
Practice Address - Phone:415-664-1414
Practice Address - Fax:415-664-7741
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker