Healthcare Provider Details

I. General information

NPI: 1588076673
Provider Name (Legal Business Name): JOHN MARK GEISS D.O. MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2014
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2592 N SANTIAGO BLVD
ORANGE CA
92867-1862
US

IV. Provider business mailing address

1050 E YORBA LINDA BLVD SUITE 104
PLACENTIA CA
92870-3730
US

V. Phone/Fax

Practice location:
  • Phone: 714-577-2271
  • Fax: 949-281-5550
Mailing address:
  • Phone: 714-223-5920
  • Fax: 714-223-5923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A12647
License Number StateCA

VIII. Authorized Official

Name: MR. JOHN MARK GEISS
Title or Position: OWNER
Credential:
Phone: 714-577-2271