Active NPI
Nicole L Green
- Contractor
- Loma Linda, CA
National Provider Identifier
1902259328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- Practice address
- 26218 Newport Ave
Loma Linda, CA 92354-4120 - Phone
- (909) 677-5111
- NPI assigned
- Jul 20, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | NV | Primary |
Addresses
Primary practice location
26218 Newport Ave
Loma Linda, CA 92354-4120
Mailing address
26218 Newport Ave
Loma Linda, CA 92354-4120
Phone (909) 677-5111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 171W00000X | Medicaid | NV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722470400000",
"number": "1902259328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26218 NEWPORT AVE",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923544120",
"telephone_number": "909-677-5111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26218 NEWPORT AVE",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923544120",
"telephone_number": "909-677-5111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "NICOLE",
"middle_name": "L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-20",
"last_updated": "2024-08-01",
"certification_date": "2024-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "NV",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "171W00000X",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Loma Linda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.