Healthcare Provider Details

I. General information

NPI: 1093891863
Provider Name (Legal Business Name): BERNARD GELLER M D ALLERGY & CLINICAL IMMUNOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 20TH ST SUITE 220
SANTA MONICA CA
90404-2050
US

IV. Provider business mailing address

1301 20TH STREET SUITE 220
SANTA MONICA CA
90404-2080
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-8534
  • Fax: 310-453-8468
Mailing address:
  • Phone: 310-828-8534
  • Fax: 310-453-8468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BERNARD DAVID GELLER
Title or Position: OWNER
Credential: M.D., PH.D.
Phone: 310-828-8534