Mary Josephine Greendale, LVN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

247161 Issued in CA

Practice address

4023 Marine Ave
Lawndale, CA 90260-1840

Phone

(310) 675-9555

NPI assigned

Dec 30, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609286400000",
    "number": "1144817610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26460 SUMMIT CIR",
            "city": "SANTA CLARITA",
            "state": "CA",
            "postal_code": "913502991",
            "telephone_number": "909-753-5763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4023 MARINE AVE",
            "city": "LAWNDALE",
            "state": "CA",
            "postal_code": "902601840",
            "telephone_number": "310-675-9555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENDALE",
        "first_name": "MARY",
        "middle_name": "JOSEPHINE",
        "name_prefix": "Mrs.",
        "credential": "LVN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-30",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "247161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Simon Reyes Go, D.C.
• Goodlife Healthcare Services
• Goretti Health Services Inc.
• Risa Beth Grand, M.D.
• Virginia C. Green, PHD
• Gregory M. Eckel, MD a Professional Corporation
• Nakia Renee Guillory-Flores
• Rommel B Guinto, D.C.
• Hagop Jack Takarlekian D.D.S Inc
• Joseph Hakimi, D.C.

• Licensed Vocational Nurse in Lawndale, CA
• Providers in Lawndale, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.