Basic Information
| Provider Information | |||||||||
| NPI: | 1093710345 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GELLER | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9602 | ||||||||
| Address2: | |||||||||
| City: | MISSION HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913469602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188375559 | ||||||||
| FaxNumber: | 8187924793 | ||||||||
| Practice Location | |||||||||
| Address1: | 18133 VENTURA BLVD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913563641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8184667700 | ||||||||
| FaxNumber: | 8189961649 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2005 | ||||||||
| LastUpdateDate: | 10/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | G60287 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | T0796 | 01 | CA | RAILROAD GROUP NUMBER | OTHER | WG60287A | 01 | CA | MEDICARE RENDERING NUMBER | OTHER | 110061982 | 01 | CA | RAILROAD RENDERING NUMBER | OTHER | YYY40048Y | 05 | CA | MEDICAID | 95-3132732 | 01 | CA | BLUE CROSS OF CALIFORNIA | OTHER | YYY40048Y | 01 | CA | BLUE SHIELD OF CALIFORNIA | OTHER |