Individual
THERESE ANNE-COLLINS GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4655 RUFFNER ST STE 270, SAN DIEGO, CA 92111-2276
(800) 787-6787
Mailing address
1381 PRITCHETT CT, LOS ALTOS, CA 94024-5712
(650) 965-0140
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
5270
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5270
PTA LICENSE
CA
Enumeration date
03/22/2007
Last updated
07/08/2007
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