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Individual

ASHA JENISE WILBORN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
1310 W STEWART DR STE 410, ORANGE, CA 92868-3855
(714) 639-9401
(714) 639-4105
Mailing address
12900 PARK PLAZA DRIVE STE 150, CERRITOS, CA 90703
(562) 282-4027

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
625834
CA
363LA2200X
Adult Health Nurse Practitioner
Primary
20529
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1912919804
TYPE 2 NPI
01
20529
NURSE PRACTITIONER LICENSE NUMBER
CA
01
625834
RN LICENSE NUMBER
CA
01
69334
PUBLIC HEALTH NURSE LICENSE NUMBER
CA
01
P01064753
RAILROAD MEDICARE
CA
Enumeration date
01/19/2011
Last updated
02/27/2018
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