Provider Demographics
NPI:1588076673
Name:JOHN MARK GEISS D.O. MEDICAL CORPORATION
Entity type:Organization
Organization Name:JOHN MARK GEISS D.O. MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:GEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-577-2271
Mailing Address - Street 1:1050 E YORBA LINDA BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3730
Mailing Address - Country:US
Mailing Address - Phone:714-223-5920
Mailing Address - Fax:714-223-5923
Practice Address - Street 1:2592 N SANTIAGO BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-1862
Practice Address - Country:US
Practice Address - Phone:714-577-2271
Practice Address - Fax:949-281-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-23
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12647207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7161950001Medicare PIN