Provider Demographics
NPI:1063733640
Name:GREENE, TATIANA MORALES (DO)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:MORALES
Last Name:GREENE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TATIANA
Other - Middle Name:
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:180 HARBOR SQ LOOP NE UNIT B123
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2449
Mailing Address - Country:US
Mailing Address - Phone:925-212-4952
Mailing Address - Fax:
Practice Address - Street 1:180 HARBOR SQ LOOP NE UNIT B123
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2449
Practice Address - Country:US
Practice Address - Phone:925-672-8835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program