Organization
IVOR GREEN M.D. A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVOR GREEN M.D. (PRESIDENT)
(818) 825-9423
Entity
Organization
Contact information
Practice address
438 W LAS TUNAS DR, SAN GABRIEL, CA 91776-1216
(626) 289-5454
(626) 457-7172
Mailing address
225 S LAKE AVE, 535, PASADENA, CA 91101-3005
(626) 795-6596
(626) 795-8247
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A253490
BLUE SHIELD
CA
05
—
00A253490
—
CA
Enumeration date
08/05/2006
Last updated
02/25/2008
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