Provider Demographics
NPI:1366181455
Name:GREEN, TAMEKA SHEA
Entity type:Individual
Prefix:
First Name:TAMEKA
Middle Name:SHEA
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16711 CIVIC CENTER DRIVE, 6
Mailing Address - Street 2:6
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706
Mailing Address - Country:US
Mailing Address - Phone:562-246-4446
Mailing Address - Fax:
Practice Address - Street 1:16711 CIVIC CENTER DRIVE, 6
Practice Address - Street 2:6
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706
Practice Address - Country:US
Practice Address - Phone:562-246-4446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7597093654251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health