Healthcare Provider Details

I. General information

NPI: 1336305036
Provider Name (Legal Business Name): ANOUSHEH ASHOURI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6926 BROCKTON AVE STE 8
RIVERSIDE CA
92506-3804
US

IV. Provider business mailing address

6926 BROCKTON AVE STE 8
RIVERSIDE CA
92506-3804
US

V. Phone/Fax

Practice location:
  • Phone: 877-414-7739
  • Fax: 844-682-0372
Mailing address:
  • Phone: 877-414-7739
  • Fax: 844-682-0372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA113709
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA113709
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA113709
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: