Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | A101763 | CA |
NPI | 1295934032 |
---|---|
Provider Name | Dr. Mary Jo Harbert |
First Address | San Diego, CA 92123 |
Second Address | San Diego, CA 92123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 03/11/2014 |