Otis Greene III, SUBSTANCE USE DISORD

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

39407 Vista del Sol
Rancho Mirage, CA 92270-3283

Phone

(877) 502-3218

NPI assigned

Aug 24, 2020

Last updated

Mar 3, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kamau Akili Shabazz Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1598227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740960000000",
    "number": "1740893361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39407 VISTA DEL SOL",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922703283",
            "telephone_number": "877-502-3218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39407 VISTA DEL SOL",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922703283",
            "telephone_number": "877-502-3218"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10700 Santa Monica Blvd Ste 310",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900256588",
            "country_code": "US",
            "telephone_number": "866-230-8275",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11720 El Camino Real Ste 200",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921302244",
            "country_code": "US",
            "telephone_number": "866-616-9360",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "506 W Graham Ave Ste 106",
            "address_purpose": "LOCATION",
            "city": "Lake Elsinore",
            "state": "CA",
            "postal_code": "925303665",
            "country_code": "US",
            "telephone_number": "888-638-8457",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREENE",
        "first_name": "OTIS",
        "name_suffix": "III",
        "credential": "SUBSTANCE USE DISORD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-24",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAMAU",
            "last_name": "SHABAZZ",
            "middle_name": "AKILI",
            "credential": "SUBSTANCE USE DISORD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Russell J Grant, M.D.
• Alissa Graves
• Johann G. Gray, MD
• Grcy Pharmacies, LLC (Gelsons Pharmacy)
• Donald James Greco, MD
• Robert B Greene, MD
• Akum Bir Singh Grewal, MD
• Glenn Griffin, DPM
• Christine Louise Griswold, MD
• Michael Frederick Griswold, RNFA CNS

• Addiction (Substance Use Disorder) Counselor in Rancho Mirage, CA
• Providers in Rancho Mirage, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2025; 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.