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General NPI Number Information
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NPI Number | 1710947841
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Entity Type | Individual
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Provider Name | JOSEPH ISAIAH WILLIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 09/03/2015
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Provider Practice Location Address
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Address Line | 20540 VIA TARARA
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City | YORBA LINDA
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State | CA
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Zip | 92887-3204
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Country | US
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Telephone | 714-701-9560
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Fax |
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Provider Business Mailing Address
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Address Line | 20540 VIA TARARA
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City | YORBA LINDA
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State | CA
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Zip | 92887-3204
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Country | US
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Telephone | 714-701-9560
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G32748
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | G32748
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G32748
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License Number State | CA
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