Healthcare Provider Details

I. General information

NPI: 1407299886
Provider Name (Legal Business Name): MICHAEL D. GEIS, MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 E. VICTORIA ST. SUITE: REAR COTTAGE
SANTA BARBARA CA
93101
US

IV. Provider business mailing address

27 E. VICTORIA ST. SUITE: REAR COTTAGE
SANTA BARBARA CA
93101
US

V. Phone/Fax

Practice location:
  • Phone: 805-962-8782
  • Fax: 805-966-4279
Mailing address:
  • Phone: 805-962-8782
  • Fax: 805-966-4279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberG25281
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG25281
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL DEWEY GEIS
Title or Position: PRESIDENT OF CORPORATION
Credential: M.D.
Phone: 805-962-8782