Provider Demographics
NPI:1053602151
Name:GREEN, CHERYL LEA (MD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:LEA
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:BEHAVIORAL HEALTH INSTITUE, LOMA LINDA UNIVERSITY
Mailing Address - Street 2:1686 BARTON RD
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-1489
Mailing Address - Country:US
Mailing Address - Phone:909-558-9547
Mailing Address - Fax:
Practice Address - Street 1:BEHAVIORAL MEDICINE CENTER, LOMA LINDA UNIVERSITY
Practice Address - Street 2:1710 BARTON RD
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5304
Practice Address - Country:US
Practice Address - Phone:909-558-9219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2018-03-17
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Provider Licenses
StateLicense IDTaxonomies
CA1413662084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry