Healthcare Provider Details

I. General information

NPI: 1093710345
Provider Name (Legal Business Name): MARK L GELLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18133 VENTURA BLVD SUITE 204
TARZANA CA
91356-3641
US

IV. Provider business mailing address

PO BOX 9602
MISSION HILLS CA
91346-9602
US

V. Phone/Fax

Practice location:
  • Phone: 818-466-7700
  • Fax: 818-996-1649
Mailing address:
  • Phone: 818-837-5559
  • Fax: 818-792-4793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberG60287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: