Individual
GEOFFREY RILEY GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1100 WEST STEWART DRIVE, ORANGE, CA 92868-3849
(714) 633-9111
Mailing address
PO BOX 690, LONG BEACH, CA 90801-0690
(562) 809-3547
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA17453
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA17453
—
CA
Enumeration date
07/07/2006
Last updated
01/13/2010
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