Healthcare Provider Details

I. General information

NPI: 1073754081
Provider Name (Legal Business Name): JUDITH WILBER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2009
Last Update Date: 03/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 BAYSHORE BLVD
BRISBANE CA
94005-1021
US

IV. Provider business mailing address

3260 BAYSHORE BLVD
BRISBANE CA
94005-1021
US

V. Phone/Fax

Practice location:
  • Phone: 415-287-2300
  • Fax: 415-287-2450
Mailing address:
  • Phone: 415-287-2300
  • Fax: 415-287-2450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License NumberDRI42
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: