MEDICARE: HOLLY ANNE GLOUDEMANS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	95017289	CA
2	363LF0000X	Family Nurse Practitioner	95017289	CA

General Provider Information

NPI Number	:	1144804550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY ANNE GLOUDEMANS

Provider Business Mailing Address
First Line	:	4140 W 190TH ST
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-5513
Country	:	US
Telephone Number	:	310-385-2992
Fax Number	:	310-385-2973

Provider Business Practice Location Address
First Line	:	99 N LA CIENEGA BLVD STE M102
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2288
Country	:	US
Telephone Number	:	310-358-2992
Fax Number	:	310-358-2973

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2021
Last Update Date	:	03/03/2025

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Directions to “ HOLLY ANNE GLOUDEMANS ” Practice Location

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