MEDICARE: ANOUSHEH ASHOURI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A113709	CA
2	208000000X	Pediatrics Physician	A113709	CA
3	208M00000X	Hospitalist Physician	A113709	CA

General Provider Information

NPI Number	:	1336305036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANOUSHEH ASHOURI M.D.

Provider Business Mailing Address
First Line	:	6926 BROCKTON AVE STE 8
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3804
Country	:	US
Telephone Number	:	877-414-7739
Fax Number	:	844-682-0372

Provider Business Practice Location Address
First Line	:	6926 BROCKTON AVE STE 8
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3804
Country	:	US
Telephone Number	:	877-414-7739
Fax Number	:	844-682-0372

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2008
Last Update Date	:	02/25/2025

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