Provider Demographics
NPI:1578617650
Name:GOLL, JOANNA P (NP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:P
Last Name:GOLL
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Gender:F
Credentials:NP
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Mailing Address - Street 1:12660 RIVERSIDE DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3429
Mailing Address - Country:US
Mailing Address - Phone:818-487-0040
Mailing Address - Fax:818-487-0050
Practice Address - Street 1:5805 SEPULVEDA BLVD
Practice Address - Street 2:SUITE 610
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2546
Practice Address - Country:US
Practice Address - Phone:818-908-8048
Practice Address - Fax:818-908-8072
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
CA499016363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA499016OtherSTATE LICENSE
CAMG1079804OtherDEA REGISTRATION