Individual
DR. KEITH GREGORY HEINZERLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1301 20TH ST STE 540, SANTA MONICA, CA 90404-2118
(310) 582-7612
(424) 277-6342
Mailing address
1920 COLORADO AVE, SANTA MONICA, CA 90404-3414
(310) 319-4700
(310) 393-5659
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A79201
CA
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
A79201
CA
Other
Enumeration date
09/22/2006
Last updated
04/13/2021
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