Healthcare Provider Details

I. General information

NPI: 1821128000
Provider Name (Legal Business Name): GIA CRECELIUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MOTOR AVE
LOS ANGELES CA
90034-3710
US

IV. Provider business mailing address

10231 MOSSY ROCK CIR
LOS ANGELES CA
90077-2113
US

V. Phone/Fax

Practice location:
  • Phone: 310-836-1223
  • Fax: 310-837-6657
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA61228
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA061228
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: