Individual
CHANEL GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
700 W 19TH ST, COSTA MESA, CA 92627-3517
(949) 866-3600
Mailing address
700 W 19TH ST, COSTA MESA, CA 92627-3517
(949) 866-3600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
CA
Other
Enumeration date
09/20/2023
Last updated
08/29/2024
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