Provider Demographics
NPI:1285676056
Name:WILBURNE, HARRIET JANICE (MD)
Entity type:Individual
Prefix:DR
First Name:HARRIET
Middle Name:JANICE
Last Name:WILBURNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:25550 HAWTHORNE BLVD
Mailing Address - Street 2:214
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6825
Mailing Address - Country:US
Mailing Address - Phone:310-303-3963
Mailing Address - Fax:310-303-3948
Practice Address - Street 1:25550 HAWTHORNE BLVD
Practice Address - Street 2:214
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6825
Practice Address - Country:US
Practice Address - Phone:310-303-3963
Practice Address - Fax:310-303-3948
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG0317052084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG31705AMedicare PIN
A44842Medicare UPIN