Provider Demographics
NPI:1730781071
Name:GHEBREYOHANNES, YOHANNA
Entity type:Individual
Prefix:
First Name:YOHANNA
Middle Name:
Last Name:GHEBREYOHANNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8491 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4218
Mailing Address - Country:US
Mailing Address - Phone:310-360-7303
Mailing Address - Fax:
Practice Address - Street 1:21750 CENTER COURT DR. S SUITE 650
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703
Practice Address - Country:US
Practice Address - Phone:323-628-8671
Practice Address - Fax:855-883-6300
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015564363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily