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NPI Code Detail

MEDICARE: DR. GIA CRECELIUS MD

MEDICARE:  DR. GIA  CRECELIUS  MD
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
12084P0800XPsychiatry PhysicianA61228CA
22084P0804XChild & Adolescent Psychiatry PhysicianA061228CA

General Provider Information

NPI Number : 1821128000
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GIA CRECELIUS MD
Provider Business Mailing Address
First Line : 10231 MOSSY ROCK CIR
Second Line :
City : LOS ANGELES
State : CA
Zip : 90077-2113
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3200 MOTOR AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90034-3710
Country : US
Telephone Number : 310-836-1223
Fax Number : 310-837-6657
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2007
Last Update Date : 06/27/2013

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