MEDICARE: DR. ALEXANDER GEISELER MBBS

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	A145034	CA

General Provider Information

NPI Number	:	1770996167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER GEISELER MBBS

Provider Business Mailing Address
First Line	:	24422 AVENIDA DE LA CARLOTA STE 300
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3628
Country	:	US
Telephone Number	:	949-599-2434
Fax Number	:	949-599-2430

Provider Business Practice Location Address
First Line	:	2920 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-2128
Country	:	US
Telephone Number	:	238-259-2233
Fax Number	:

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

Provider Enumeration Date	:	06/04/2014
Last Update Date	:	03/02/2022

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