Provider Demographics
NPI:1235149675
Name:GEIGER, MITCHELL (MD)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:
Last Name:GEIGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 MAGNOLIA AVE
Mailing Address - Street 2:STE 1D
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3120
Mailing Address - Country:US
Mailing Address - Phone:951-734-7562
Mailing Address - Fax:951-734-7683
Practice Address - Street 1:770 MAGNOLIA AVE
Practice Address - Street 2:STE 1D
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3120
Practice Address - Country:US
Practice Address - Phone:951-734-7562
Practice Address - Fax:951-734-7683
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G697950207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA126759600OtherDEPT OF LABOR
CAG31053Medicare UPIN
CA00G697950Medicare ID - Type Unspecified