Individual
IVAN JEROME GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3762 TUNDRA SWAN ST, LAS VEGAS, NV 89122-3536
(323) 212-0072
Mailing address
3762 TUNDRA SWAN ST, LAS VEGAS, NV 89122-3536
(323) 212-0072
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
09/05/2023
Last updated
09/05/2023
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