Healthcare Provider Details

I. General information

NPI: 1104985845
Provider Name (Legal Business Name): KELLIE D. CURTIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18436 ROSCOE BLVD
NORTHRIDGE CA
91325-4107
US

IV. Provider business mailing address

4100 GUARDIAN ST STE 205
SIMI VALLEY CA
93063-6721
US

V. Phone/Fax

Practice location:
  • Phone: 818-435-1400
  • Fax: 818-435-1492
Mailing address:
  • Phone: 855-504-4544
  • Fax: 805-577-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA96199
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA96199
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: