Individual
JORDAN ISIAH ANTHONY WILBORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
265 S ANITA DR STE 201, ORANGE, CA 92868-3346
(714) 410-3500
(714) 470-3527
Mailing address
2345 E COMMONWEALTH AVE APT 18, FULLERTON, CA 92831-4277
(323) 742-2700
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
42594
CA
Other
Enumeration date
08/03/2021
Last updated
07/23/2024
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