Provider Demographics
NPI:1518980689
Name:CURTIS, JOHN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:CURTIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11777 SAN VICENTE BLVD STE 703
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5052
Mailing Address - Country:US
Mailing Address - Phone:310-699-7788
Mailing Address - Fax:424-832-7649
Practice Address - Street 1:11777 SAN VICENTE BLVD STE 703
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-5052
Practice Address - Country:US
Practice Address - Phone:310-204-8700
Practice Address - Fax:310-440-0015
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7148103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP7148GMedicare ID - Type UnspecifiedMEDICARE NUMBER