Healthcare Provider Details

I. General information

NPI: 1285676056
Provider Name (Legal Business Name): HARRIET JANICE WILBURNE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25550 HAWTHORNE BLVD 214
TORRANCE CA
90505-6825
US

IV. Provider business mailing address

25550 HAWTHORNE BLVD 214
TORRANCE CA
90505-6825
US

V. Phone/Fax

Practice location:
  • Phone: 310-303-3963
  • Fax: 310-303-3948
Mailing address:
  • Phone: 310-303-3963
  • Fax: 310-303-3948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG031705
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberG031705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: