Provider Demographics
NPI:1710947841
Name:WILLIS, JOSEPH ISAIAH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ISAIAH
Last Name:WILLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20540 VIA TARARA
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-3204
Mailing Address - Country:US
Mailing Address - Phone:714-701-9560
Mailing Address - Fax:
Practice Address - Street 1:20540 VIA TARARA
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-3204
Practice Address - Country:US
Practice Address - Phone:714-701-9560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG327482085R0202X, 2085U0001X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G327480Medicaid
CAA91473Medicare UPIN
CA00G327480Medicaid