Henrietta Anne Green, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

17577 Arrow Blvd
Fontana, CA 92335-4011

Phone

(909) 823-4454

NPI assigned

Sep 10, 2019

Sex

Female

Sole proprietor

No

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

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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

{
    "created_epoch": "1568073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568073600000",
    "number": "1548819634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 N IDYLLWILD AVE",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923764814",
            "telephone_number": "909-496-1532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17577 ARROW BLVD",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923354011",
            "telephone_number": "909-823-4454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "HENRIETTA",
        "middle_name": "ANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-10",
        "last_updated": "2019-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alicia Christina Gray, MS
• Summer Margaret Gray
• Great I Am Welfare and Development Home Health Agency LLC
• Green Merrylands Inc
• Dominnique Green
• Damon Lamont Greene, M.D.
• Tambra Greene, LCSW
• Divine Kaur Grewal, PHARMD
• Larry B. Gridley, MD
• Laura Gridley, MD

• Medical Physician Assistant in Fontana, CA
• Providers in Fontana, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2019; 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.