Provider Demographics
NPI:1568868263
Name:GREAN, RACHEL ALI (PA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ALI
Last Name:GREAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:180 NEWPORT CENTER DR STE 270
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-6998
Mailing Address - Country:US
Mailing Address - Phone:949-868-6382
Mailing Address - Fax:949-720-1172
Practice Address - Street 1:180 NEWPORT CENTER DR STE 270
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-6998
Practice Address - Country:US
Practice Address - Phone:949-868-6382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA52517207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology