Provider Demographics
NPI:1871721043
Name:GREEN, JANELLE P (DPM)
Entity type:Individual
Prefix:DR
First Name:JANELLE
Middle Name:P
Last Name:GREEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 HARKNESS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94134-2122
Mailing Address - Country:US
Mailing Address - Phone:415-902-2134
Mailing Address - Fax:510-444-1966
Practice Address - Street 1:5709 MARKET ST STE I
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-2811
Practice Address - Country:US
Practice Address - Phone:415-902-2134
Practice Address - Fax:909-706-3942
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
CAE5039213EP1101X, 213ES0103X, 213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB229206OtherMEDICARE PTAN SO CAL
CACA144219OtherMEDICARE PTAN NO CAL
CAE5039OtherCA DPM LICENSE
CA1581343Medicaid