Provider Demographics
NPI:1669026191
Name:WILTERMOOD, CURTIS GREGORY
Entity Type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:GREGORY
Last Name:WILTERMOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 FULTON PL
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-9474
Mailing Address - Country:US
Mailing Address - Phone:707-540-4664
Mailing Address - Fax:
Practice Address - Street 1:164 FULTON PL
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-9474
Practice Address - Country:US
Practice Address - Phone:707-540-4664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician