Individual
MACK GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
16008 KAMANA RD, SUITE 100, APPLE VALLEY, CA 92307-1376
(760) 956-5200
(760) 669-0793
Mailing address
12277 APPLE VALLEY RD, PMB 288, APPLE VALLEY, CA 92308-1701
(760) 956-5200
(760) 669-0793
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
A1259029
CA
Other
Enumeration date
06/17/2010
Last updated
09/28/2015
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