Basic Information
| Provider Information | |||||||||
| NPI: | 1447433974 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREENE | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | ZACHARY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 646 N H ST | ||||||||
| Address2: | |||||||||
| City: | LOMPOC | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934364519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8058651943 | ||||||||
| FaxNumber: | 8058651954 | ||||||||
| Practice Location | |||||||||
| Address1: | 646 N H ST | ||||||||
| Address2: | |||||||||
| City: | LOMPOC | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934364519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8058651943 | ||||||||
| FaxNumber: | 8058651954 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2007 | ||||||||
| LastUpdateDate: | 12/06/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.