Healthcare Provider Details

I. General information

NPI: 1063825289
Provider Name (Legal Business Name): J M GEISS DO APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HUTTON CENTRE DR STE 950
SANTA ANA CA
92707-8714
US

IV. Provider business mailing address

5 HUTTON CENTRE DR STE 950
SANTA ANA CA
92707-8714
US

V. Phone/Fax

Practice location:
  • Phone: 855-434-7763
  • Fax: 949-981-5550
Mailing address:
  • Phone: 855-434-7763
  • Fax: 949-981-5550

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: ANGELICA LEYLA SOTO
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 855-434-7763