Healthcare Provider Details

I. General information

NPI: 1740157478
Provider Name (Legal Business Name): HOLLY THARBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 W MANCHESTER BLVD
INGLEWOOD CA
90305-2514
US

IV. Provider business mailing address

110 W 6TH ST APT 201
LONG BEACH CA
90802-1349
US

V. Phone/Fax

Practice location:
  • Phone: 310-644-8400
  • Fax:
Mailing address:
  • Phone: 424-380-8094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number95037365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: