Individual
HENRIETTA ANNE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
17577 ARROW BLVD, FONTANA, CA 92335-4011
(909) 823-4454
Mailing address
660 N IDYLLWILD AVE, RIALTO, CA 92376-4814
(909) 496-1532
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
09/10/2019
Last updated
09/10/2019
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