Healthcare Provider Details

I. General information

NPI: 1255268348
Provider Name (Legal Business Name): DIVINE DESIGN HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3662 REGAL PL
LOS ANGELES CA
90068-1230
US

IV. Provider business mailing address

500 S SEPULVEDA BLVD FL 4
LOS ANGELES CA
90049-3550
US

V. Phone/Fax

Practice location:
  • Phone: 323-874-2565
  • Fax:
Mailing address:
  • Phone: 323-874-2565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: DEBRA KREUTER
Title or Position: OWNER/MANAGER
Credential: BSN, RN, CFMP
Phone: 323-874-2565