MEDICARE: HERMAN GELLER MD, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	C14968	CA

General Provider Information

NPI Number	:	1417184201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERMAN GELLER MD, INC.

Provider Business Mailing Address
First Line	:	297B W ARTESIA ST
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91768-1808
Country	:	US
Telephone Number	:	909-623-1303
Fax Number	:	909-397-5293

Provider Business Practice Location Address
First Line	:	297B W ARTESIA ST
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91768-1808
Country	:	US
Telephone Number	:	909-623-1303
Fax Number	:	909-397-5293

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HERMAN M GELLER
Credential	:	MD
Telephone Number	:	909-623-1303

Provider Enumeration Date	:	06/18/2009
Last Update Date	:	10/08/2015

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