Healthcare Provider Details

I. General information

NPI: 1316826233
Provider Name (Legal Business Name): MARISSA HOLCOMB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

767 N HILL ST STE 400B
LOS ANGELES CA
90012-2381
US

IV. Provider business mailing address

767 N HILL ST STE 400B
LOS ANGELES CA
90012-2381
US

V. Phone/Fax

Practice location:
  • Phone: 213-808-1792
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95041036
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: