MEDICARE: DIVINE DESIGN HEALTH

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
1	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1255268348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE DESIGN HEALTH

Provider Business Mailing Address
First Line	:	500 S SEPULVEDA BLVD FL 4
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-3550
Country	:	US
Telephone Number	:	323-874-2565
Fax Number	:

Provider Business Practice Location Address
First Line	:	3662 REGAL PL
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90068-1230
Country	:	US
Telephone Number	:	323-874-2565
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	DEBRA KREUTER
Credential	:	BSN, RN, CFMP
Telephone Number	:	323-874-2565

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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Directions to “DIVINE DESIGN HEALTH ” Practice Location

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