Organization
GREEN DERMATOLOGIC MEDICAL GROUP A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER E GREEN M. D. (MEDICAL DOCTOR)
(949) 496-6066
Entity
Organization
Contact information
Practice address
657 CAMINO DE LOS MARES STE 242, SAN CLEMENTE, CA 92673-2811
(949) 496-6066
(949) 496-6497
Mailing address
657 CAMINO DE LOS MARES STE 242, SAN CLEMENTE, CA 92673-2811
(949) 496-6066
(949) 496-6497
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
C36384
CA
Other
Enumeration date
05/04/2007
Last updated
05/04/2018
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