Healthcare Provider Details

I. General information

NPI: 1386294460
Provider Name (Legal Business Name): SAMIRA SHOKOOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7117 BROCKTON AVE
RIVERSIDE CA
92506-2658
US

IV. Provider business mailing address

7117 BROCKTON AVE
RIVERSIDE CA
92506-2658
US

V. Phone/Fax

Practice location:
  • Phone: 951-782-3725
  • Fax: 951-784-3267
Mailing address:
  • Phone: 951-782-3725
  • Fax: 951-784-3267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95012215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: