Healthcare Provider Details

I. General information

NPI: 1073402947
Provider Name (Legal Business Name): SENIOR DOC NEW MEXICO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARQUETTE AVE NW STE 1200
ALBUQUERQUE NM
87102-5312
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:
Mailing address:
  • Phone: 855-434-7763
  • Fax: 949-281-5550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN MARK GEISS
Title or Position: CEO
Credential: DO
Phone: 855-434-7763