Healthcare Provider Details

I. General information

NPI: 1578617650
Provider Name (Legal Business Name): JOANNA P GOLL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 SEPULVEDA BLVD SUITE 610
VAN NUYS CA
91411-2546
US

IV. Provider business mailing address

12660 RIVERSIDE DR SUITE 225
NORTH HOLLYWOOD CA
91607-3429
US

V. Phone/Fax

Practice location:
  • Phone: 818-908-8048
  • Fax: 818-908-8072
Mailing address:
  • Phone: 818-487-0040
  • Fax: 818-487-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number499016
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: