Provider Demographics
NPI:1295423374
Name:GREEN, NICOLE M (PHD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:M
Last Name:GREEN
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:12750 ERICKSON AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-4024
Mailing Address - Country:US
Mailing Address - Phone:562-658-1330
Mailing Address - Fax:562-401-5999
Practice Address - Street 1:12750 ERICKSON AVE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-4024
Practice Address - Country:US
Practice Address - Phone:562-658-1330
Practice Address - Fax:562-401-5999
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPHM2116246QM0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMicrobiology