Provider Demographics
NPI:1083259881
Name:GELLER, KEVIN JOEL
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOEL
Last Name:GELLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 SIERRA COLLEGE BLVD APT 1014
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-6419
Mailing Address - Country:US
Mailing Address - Phone:913-904-8204
Mailing Address - Fax:
Practice Address - Street 1:8800 SIERRA COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-9566
Practice Address - Country:US
Practice Address - Phone:913-904-8204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator