Healthcare Provider Details

I. General information

NPI: 1245177633
Provider Name (Legal Business Name): JOHNELL HOLBERT NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 E MAPLE AVE
EL SEGUNDO CA
90245-6507
US

IV. Provider business mailing address

6220 CANTERBURY DR APT 208
CULVER CITY CA
90230-7917
US

V. Phone/Fax

Practice location:
  • Phone: 310-375-2705
  • Fax:
Mailing address:
  • Phone: 213-709-3345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95150874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: