Provider Demographics
NPI:1588704365
Name:NEELY, KRYSTAL M (MD)
Entity type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:M
Last Name:NEELY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 4636
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90231-4636
Mailing Address - Country:US
Mailing Address - Phone:310-701-9766
Mailing Address - Fax:310-763-2315
Practice Address - Street 1:403 S LONG BEACH BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3449
Practice Address - Country:US
Practice Address - Phone:323-774-6551
Practice Address - Fax:310-763-2315
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA69107208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics