Individual
KURT WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
18700 OXNARD ST, TARZANA, CA 91356-1413
(818) 996-1051
Mailing address
1830 GRACE AVE APT 1, HOLLYWOOD, CA 90028-4880
(818) 913-1964
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
446078
CA
Other
Enumeration date
07/14/2025
Last updated
07/14/2025
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