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General NPI Number Information
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NPI Number | 1245177633
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Entity Type | Individual
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Provider Name | JOHNELL HOLBERT NP
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Gender | Male
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Dates
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Enumeration Date | 05/02/2026
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Last Update Date | 05/02/2026
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Provider Practice Location Address
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Address Line | 2232 E MAPLE AVE
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City | EL SEGUNDO
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State | CA
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Zip | 90245-6507
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Country | US
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Telephone | 310-375-2705
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Fax |
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Provider Business Mailing Address
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Address Line | 6220 CANTERBURY DR APT 208
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City | CULVER CITY
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State | CA
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Zip | 90230-7917
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Country | US
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Telephone | 213-709-3345
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 95150874
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License Number State | CA
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