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General NPI Number Information
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NPI Number | 1659947984
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Entity Type | Individual
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Provider Name | AMANDA M WILBUR
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Gender | Female
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Dates
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Enumeration Date | 05/27/2021
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 6840 INDIANA AVE STE 275
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City | RIVERSIDE
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State | CA
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Zip | 92506-4279
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Country | US
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Telephone | 951-788-0230
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Fax |
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Provider Business Mailing Address
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Address Line | 2751 RECHE CANYON RD UNIT SP85
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City | COLTON
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State | CA
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Zip | 92324-9570
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Country | US
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Telephone | 951-285-9890
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW99373
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License Number State | CA
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