Healthcare Provider Details

I. General information

NPI: 1811861040
Provider Name (Legal Business Name): PAUL DANIEL WILLIS JR. RADTI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 A ST
ANTIOCH CA
94509-2331
US

IV. Provider business mailing address

4141 ROCKFORD DR
ANTIOCH CA
94509-6973
US

V. Phone/Fax

Practice location:
  • Phone: 925-978-2873
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1621290725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: