MEDICARE: DR. HEATHER V. KRELL M.D., M.P.H.

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	2084P0804X	Child & Adolescent Psychiatry Physician	G85426	CA
2	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician	G85426	CA
3	2084P0800X	Psychiatry Physician	G85426	CA

General Provider Information

NPI Number	:	1386815496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER V. KRELL M.D., M.P.H.

Provider Business Mailing Address
First Line	:	111 LAKE GLORIA DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-2259
Country	:	US
Telephone Number	:	310-487-8784
Fax Number	:

Provider Business Practice Location Address
First Line	:	12100 WILSHIRE BLVD
Second Line	:	SUITE 800
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-7120
Country	:	US
Telephone Number	:	310-428-8676
Fax Number	:	310-471-1740

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2008
Last Update Date	:	01/23/2020

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