Basic Information
| Provider Information | |||||||||
| NPI: | 1730314576 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREENE | ||||||||
| FirstName: | DEANNA | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | LVN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1977 N GAREY AVE | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917672774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096236651 | ||||||||
| FaxNumber: | 9096230455 | ||||||||
| Practice Location | |||||||||
| Address1: | 11927 ELLIOTT AVE | ||||||||
| Address2: | |||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917323740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263505304 | ||||||||
| FaxNumber: | 6263500756 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2009 | ||||||||
| LastUpdateDate: | 05/22/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 240383 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
ID Information
| ID | Type | State | Issuer | Description | BRI5533 | 01 | CA | LACDMH STAFF CODE | OTHER |