Provider Demographics
NPI:1639258239
Name:GELLER MEDICAL CORPORATION
Entity Type:Organization
Organization Name:GELLER MEDICAL CORPORATION
Other - Org Name:UNITED PHYSICIANS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:GREGSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-630-8400
Mailing Address - Street 1:465 COLLEGE BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-5435
Mailing Address - Country:US
Mailing Address - Phone:760-630-8400
Mailing Address - Fax:760-630-8594
Practice Address - Street 1:611 K ST UNIT B
Practice Address - Street 2:PMB#371
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-7091
Practice Address - Country:US
Practice Address - Phone:760-207-2768
Practice Address - Fax:760-557-2309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19135111N00000X
CADC25424111N00000X
CA20A8052208100000X
CAPT26629225100000X
CAAT2851225200000X
CAPA17862363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15687Medicare ID - Type Unspecified