MEDICARE: RYAN LEE GELLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst	1-21-52055	CA

General Provider Information

NPI Number	:	1164938668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN LEE GELLER

Provider Business Mailing Address
First Line	:	1318 POWDERHORN WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-1473
Country	:	US
Telephone Number	:	760-914-3788
Fax Number	:

Provider Business Practice Location Address
First Line	:	2202 PLAZA DR
Second Line	:
City	:	ROCKLIN
State	:	CA
Zip	:	95765-4404
Country	:	US
Telephone Number	:	916-749-4646
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2017
Last Update Date	:	08/18/2022

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Directions to “ RYAN LEE GELLER ” Practice Location

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