Provider Demographics
NPI:1386815496
Name:KRELL, HEATHER V (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:V
Last Name:KRELL
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 LAKE GLORIA DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-2259
Mailing Address - Country:US
Mailing Address - Phone:310-487-8784
Mailing Address - Fax:
Practice Address - Street 1:12100 WILSHIRE BLVD
Practice Address - Street 2:SUITE 800
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7120
Practice Address - Country:US
Practice Address - Phone:310-428-8676
Practice Address - Fax:310-471-1740
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG854262084P0804X, 2084P2900X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine