Healthcare Provider Details

I. General information

NPI: 1821023037
Provider Name (Legal Business Name): JORDAN GELLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E SUITE 1812
LOS ANGELES CA
90067-2001
US

IV. Provider business mailing address

2080 CENTURY PARK E SUITE 1812
LOS ANGELES CA
90067-2001
US

V. Phone/Fax

Practice location:
  • Phone: 310-277-1812
  • Fax: 310-300-0189
Mailing address:
  • Phone: 310-277-1812
  • Fax: 310-651-6076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA80569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: