Provider Demographics
NPI:1811870462
Name:YIBALIH, GEBREHIWOT HAILU (FNP)
Entity type:Individual
Prefix:
First Name:GEBREHIWOT
Middle Name:HAILU
Last Name:YIBALIH
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 WELLINGTON RD APT 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-1880
Mailing Address - Country:US
Mailing Address - Phone:323-470-7025
Mailing Address - Fax:
Practice Address - Street 1:7136 HASKELL AVE STE 205
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4112
Practice Address - Country:US
Practice Address - Phone:818-908-4086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF07251146363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily