Individual
EDIE WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1520 SAN PABLO ST STE 1000, LOS ANGELES, CA 90033-5312
(323) 442-5100
Mailing address
PO BOX 31309, LOS ANGELES, CA 90031-0309
(323) 442-5100
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
008351
GA
363AM0700X
Medical Physician Assistant
Primary
PA62067
CA
Other
Enumeration date
05/11/2017
Last updated
03/14/2023
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