Provider Demographics
NPI: | 1063825289 |
---|---|
Name: | J.M. GEISS, D.O. APC |
Entity Type: | Organization |
Organization Name: | J.M. GEISS, D.O. APC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JOHN |
Authorized Official - Middle Name: | MARK |
Authorized Official - Last Name: | GEISS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DO |
Authorized Official - Phone: | 714-872-2144 |
Mailing Address - Street 1: | 2592 N SANTIAGO BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | ORANGE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92867-1862 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 714-577-2271 |
Mailing Address - Fax: | 949-981-5550 |
Practice Address - Street 1: | 2592 N SANTIAGO BLVD |
Practice Address - Street 2: | |
Practice Address - City: | ORANGE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92867-1862 |
Practice Address - Country: | US |
Practice Address - Phone: | 714-577-2271 |
Practice Address - Fax: | 949-981-5550 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-06-05 |
Last Update Date: | 2021-02-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 20A12647 | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty |