Graham Green | San Diego, CA • PECOS Search

Graham Green

General Practice

Allopathic & Osteopathic Physicians

34800 Bob Wilson Dr, San Diego, CA 92134-1098

PECOS Enrollment

Based on the most recent information from CMS, provider Graham Green does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1619733839
Provider Type
Individual
Full Name
Green, Graham
Credential
DO

Gender
Male
Sole Proprietor
No
Enumeration Date
2/26/2024
Last Updated
2/23/2026

Contact Information

Practice Location

34800 Bob Wilson Dr, San Diego, CA 92134-1098

Unlisted Fax

Mailing Location

34800 Bob Wilson Dr, San Diego, CA 92134-1098

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 208D00000X Primary	Description General Practice Allopathic & Osteopathic Physicians	License 0102209476 Virginia