PSYCHEDELIC MEDICAL ASSOCIATES PC NPI 1588341689

NPI Information

  • NPI: 1588341689
  • Provider Name: PSYCHEDELIC MEDICAL ASSOCIATES PC
  • Classification: Internal Medicine - 207RA0401X
  • Specialization: Addiction Medicine
  • Entity Type: Organization
  • Address: 1247 7TH ST STE 300
    SANTA MONICA, CA
    ZIP 90401
  • Phone: (310) 393-7129

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NPI Details

PSYCHEDELIC MEDICAL ASSOCIATES PC is an addiction medicine internal medicine in Santa Monica, CA. The provider is an internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. PSYCHEDELIC MEDICAL ASSOCIATES PC NPI is 1588341689. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

1247 7TH ST STE 300
SANTA MONICA, CA
ZIP 90401-644
Phone: (310) 393-7129
Fax: (310) 564-7839

The provider's authorized official is Keith Heinzerling .
The authorized official title is Director and has the following contact phone number (310) 393-7129.

The enumeration date for this NPI number is 6/29/2023 and was last updated on 6/29/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1106H00000XMarriage & Family TherapistNo
2207RA0401XInternal MedicineAddiction MedicineYes

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This page was last updated on: 11/21/2025

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