Individual provider Active NPI

Ismail Al Huwaitat

  • Psychiatric/Mental Health Nurse Practitioner
  • Harbor City, CA
National Provider Identifier
1295686129
Registry record updated Feb 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95036620 Issued in CA
Practice address
25825 Vermont Ave
Harbor City, CA 90710-3518
Phone
(833) 574-2273
NPI assigned
Feb 6, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95036620 CA Primary

Addresses

Primary practice location

25825 Vermont Ave
Harbor City, CA 90710-3518

Mailing address

25825 Vermont Ave
Harbor City, CA 90710-3518
Phone (833) 574-2273

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260413002761 CA Practitioner - Nurse Practitioner 7911472329 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ehab Yacoub MD IncGroup PAC ID 5092099523, 179 clinicians

Practice addresses (Care Compare)

1225 W 190TH St
Suite 280
Gardena, CA 90248-4305
Phone (877) 515-8113

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
95036620CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ehab Yacoub MD Inc. CurrentSince Mar 30, 2026 Accepting new patients

Locations

1225 W 190th St
Ste 280
Gardena, CA 90248
Phone (310) 515-8113

901 W Civic Center Dr
Fl 2
Santa Ana, CA 92703
Phone (951) 216-3549

6320 Canoga Ave
Fl 15
Woodland Hls, CA 91367
Phone (818) 588-4003

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1770336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770336000000",
    "number": "1295686129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25825 VERMONT AVE",
            "city": "HARBOR CITY",
            "state": "CA",
            "postal_code": "907103518",
            "telephone_number": "833-574-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25825 VERMONT AVE",
            "city": "HARBOR CITY",
            "state": "CA",
            "postal_code": "907103518",
            "telephone_number": "833-574-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AL HUWAITAT",
        "first_name": "ISMAIL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-02-06",
        "last_updated": "2026-02-06",
        "certification_date": "2026-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95036620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Harbor City, CA

Sources for this page

Verify at the official NPI Registry.