Jessica Green, DVM
Individual provider Active NPI Veterinarian · Banning, CA
NPI 1356787261 · NPPES record last updated May 18, 2013
Key facts
- NPI
- 1356787261
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Veterinarian 174M00000X
- License
- 19295 (CA)
- Practice address
- 3559 W Ramsey St
Banning, CA 92220-3505 - Phone
- (951) 849-3864
- NPI assigned
- May 18, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Veterinarian | 174M00000X | 19295 | CA | Yes |
Addresses
Primary practice location
3559 W Ramsey St
Banning, CA 92220-3505
Mailing address
3559 W Ramsey St
Banning, CA 92220-3505
Phone (951) 849-3864
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 19295 | Other | CA | CALIFORNIA VETERINARY BOARD LICENSE |
Other providers in Banning, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 18, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.