Provider Demographics
NPI:1679627327
Name:GREEN, ROBIN (LAC)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15585 MONTEREY ST. STE C
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037
Mailing Address - Country:US
Mailing Address - Phone:408-776-0420
Mailing Address - Fax:408-776-0424
Practice Address - Street 1:15585 MONTEREY ST., STE C
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037
Practice Address - Country:US
Practice Address - Phone:408-776-0420
Practice Address - Fax:408-776-0424
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9249171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist