Healthcare Provider Details

I. General information

NPI: 1386346641
Provider Name (Legal Business Name): MARIE JO GEHA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CIVIC CENTER DR STE 200B
SAN RAFAEL CA
94903-5232
US

IV. Provider business mailing address

321 N MESA ST
SAN PEDRO CA
90731-2119
US

V. Phone/Fax

Practice location:
  • Phone: 415-492-3333
  • Fax:
Mailing address:
  • Phone: 310-918-8707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA207935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: