Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Green Dermatologic Medical Group a Medical Corporation

Organization Specialist · NPI 1154533685

Green Dermatologic Medical Group a Medical Corporation is a Specialist in San Clemente, California. Licensed in California. Registered with an NPI since 2007.

Licensed in
CA
In the registry since
2007

Practice location Address checks out

657 Camino De Los Mares Ste 242
San Clemente, CA 92673-2811
Phone: (949) 496-6066
Fax: (949) 496-6497
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence C36384 (CA)

Record details

NPI number1154533685
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Roger Green — Medical Doctor · (949) 496-6066
NPI enumeratedMay 4, 2007
Last updated in NPPESMay 4, 2018
Mailing address657 Camino De Los Mares Ste 242, San Clemente, CA 92673-2811

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