Healthcare Provider Details

I. General information

NPI: 1316906225
Provider Name (Legal Business Name): ANDREW GELERIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W ROWLAND ST
COVINA CA
91723-2943
US

IV. Provider business mailing address

420 W ROWLAND ST
COVINA CA
91723-2943
US

V. Phone/Fax

Practice location:
  • Phone: 626-331-6411
  • Fax: 626-251-1560
Mailing address:
  • Phone: 626-331-6411
  • Fax: 626-251-1560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG44192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: