Basic Information
| Provider Information | |||||||||
| NPI: | 1417055740 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIS | ||||||||
| FirstName: | HERMILA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4955 VAN NUYS BOULEVARD | ||||||||
| Address2: | SUITE 411 | ||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914031824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187841195 | ||||||||
| FaxNumber: | 8187846473 | ||||||||
| Practice Location | |||||||||
| Address1: | 4955 VAN NUYS BOULEVARD | ||||||||
| Address2: | SUITE 411 | ||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914031824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187841195 | ||||||||
| FaxNumber: | 8187846473 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 08/30/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 12346 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.