Green River Medical & Aesthetic Centre Inc.

Primary specialty

Ambulatory Family Planning FacilityTaxonomy code 261QA0005X

License

NPF20032 Issued in CA

Legal business name

GREEN RIVER MEDICAL & AESTHETIC CENTRE INC.

Practice address

2791 Green River #103
Corona, CA 92882-7426

Phone

(951) 735-5570

Fax

(951) 735-5572

NPI assigned

Jun 11, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Richard B Mantell, M.D.

Title

C.O.O

Phone

(951) 735-5570

Specialties & licenses 1

Addresses

Other names 1

• Family & Aesthetic Clinic Doing business as

Locations

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

{
    "created_epoch": "1339372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408665600000",
    "number": "1598027112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18706",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928178706",
            "telephone_number": "951-735-5570",
            "fax_number": "951-735-5572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2791 GREEN RIVER #103",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928827426",
            "telephone_number": "951-735-5570",
            "fax_number": "951-735-5572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN RIVER MEDICAL & AESTHETIC CENTRE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-11",
        "last_updated": "2014-08-22",
        "status": "A",
        "authorized_official_last_name": "MANTELL",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "C.O.O",
        "authorized_official_telephone_number": "951-735-5570",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA0005X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Family Planning Facility",
            "state": "CA",
            "license": "NPF20032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family & Aesthetic Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Greater Corona Extended Care, Inc..
• Greater Corona Sleep Diagnostic Center
• Greater Corona Sleep Diagnostic Center
• Patricia Marie Greco, NP
• Green River Congregate Living
• Arianna Green
• Raquel Green
• Tonsinetta D Green, LCSW
• Valencia Green
• Melissa Jane Greene, D.C.

• Ambulatory Family Planning Facility in Corona, CA
• Providers in Corona, CA by specialty
• Ambulatory Family Planning Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2014; 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.