Provider Demographics
NPI:1184724932
Name:HEINZERLING, KEITH GREGORY (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:GREGORY
Last Name:HEINZERLING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1920 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-3414
Mailing Address - Country:US
Mailing Address - Phone:310-319-4700
Mailing Address - Fax:310-393-5659
Practice Address - Street 1:1301 20TH ST STE 540
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2118
Practice Address - Country:US
Practice Address - Phone:310-582-7612
Practice Address - Fax:424-277-6342
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2021-04-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA79201207RA0401X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine