Healthcare Provider Details

I. General information

NPI: 1568644870
Provider Name (Legal Business Name): MARILYN LOU GELLER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9903 BASILICA CT
CYPRESS CA
90630-3537
US

IV. Provider business mailing address

9903 BASILICA CT
CYPRESS CA
90630-3537
US

V. Phone/Fax

Practice location:
  • Phone: 714-720-1104
  • Fax: 714-541-9072
Mailing address:
  • Phone: 714-720-1104
  • Fax: 714-541-9072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number225862
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: