Provider Demographics
NPI:1518778109
Name:GREEN, JEFFREY TODD
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:TODD
Last Name:GREEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 SAFFRON WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-3465
Mailing Address - Country:US
Mailing Address - Phone:530-524-5626
Mailing Address - Fax:
Practice Address - Street 1:4015 SAFFRON WAY
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-3465
Practice Address - Country:US
Practice Address - Phone:530-524-5626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty