Provider Demographics
NPI:1003301417
Name:GREEN, SALMA MOHAMMADI (DO)
Entity type:Individual
Prefix:
First Name:SALMA
Middle Name:MOHAMMADI
Last Name:GREEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11645 WIGGINS CT
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-6973
Mailing Address - Country:US
Mailing Address - Phone:909-615-3078
Mailing Address - Fax:
Practice Address - Street 1:1467 FORD ST STE 201
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-3912
Practice Address - Country:US
Practice Address - Phone:909-206-2612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS021083207Q00000X
CA20A19314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine