Provider Demographics
NPI:1811650740
Name:GELLER, ALEXANDRA
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:
Last Name:GELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4914 DIXIE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-2011
Mailing Address - Country:US
Mailing Address - Phone:970-219-6425
Mailing Address - Fax:
Practice Address - Street 1:162 S RANCHO SANTA FE RD STE A30
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4364
Practice Address - Country:US
Practice Address - Phone:858-956-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19272171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist