Healthcare Provider Details

I. General information

NPI: 1619979762
Provider Name (Legal Business Name): STEPHEN A GELLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD RM 8725
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

31255 CEDAR VALLEY DR STE 324
WESTLAKE VILLAGE CA
91362-7129
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-6627
  • Fax: 310-423-0170
Mailing address:
  • Phone: 818-338-8103
  • Fax: 818-338-8119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG049703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: