Individual
NATHANAEL GIDEON GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
23072 LAKE CENTER DR STE 115, LAKE FOREST, CA 92630-2880
(949) 406-9694
Mailing address
23072 LAKE CENTER DR STE 115, LAKE FOREST, CA 92630-2880
(949) 406-9694
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-UCZFAE
—
Other
Enumeration date
06/11/2025
Last updated
06/11/2025
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