Provider Demographics
NPI:1447541388
Name:TILLOTSON, CURTIS RYAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:RYAN
Last Name:TILLOTSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 E DEL MAR BLVD STE 12
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-6709
Mailing Address - Country:US
Mailing Address - Phone:626-585-0041
Mailing Address - Fax:626-585-1839
Practice Address - Street 1:2810 E DEL MAR BLVD STE 12
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-6709
Practice Address - Country:US
Practice Address - Phone:626-585-0041
Practice Address - Fax:626-585-1839
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24217103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical