Healthcare Provider Details

I. General information

NPI: 1801110168
Provider Name (Legal Business Name): JACQUELINE HELLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 PICO BLVD 3RD FLOOR
SANTA MONICA CA
90405-1828
US

IV. Provider business mailing address

PO BOX 491323
LOS ANGELES CA
90049-9323
US

V. Phone/Fax

Practice location:
  • Phone: 310-664-7500
  • Fax:
Mailing address:
  • Phone: 310-385-9656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG59918
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: