Healthcare Provider Details

I. General information

NPI: 1386815496
Provider Name (Legal Business Name): HEATHER V. KRELL M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12100 WILSHIRE BLVD SUITE 800
LOS ANGELES CA
90025-7120
US

IV. Provider business mailing address

111 LAKE GLORIA DR
WEST PALM BEACH FL
33411-2259
US

V. Phone/Fax

Practice location:
  • Phone: 310-428-8676
  • Fax: 310-471-1740
Mailing address:
  • Phone: 310-487-8784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberG85426
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberG85426
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG85426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: