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General NPI Number Information
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NPI Number | 1891212296
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Entity Type | Organization
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Legal Business Name | HEBA BOSHRA MD, INC.
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Dates
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Enumeration Date | 08/25/2017
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Last Update Date | 08/25/2017
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Provider Practice Location Address
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Address Line | 5900 BROCKTON AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-1862
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Country | US
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Telephone | 909-226-0198
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Fax |
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Provider Business Mailing Address
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Address Line | 6971 RUSSIAN RIVER CT
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-2063
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Country | US
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Telephone | 909-226-0198
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Fax |
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Authorized Official
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Title or Position | MD
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Name | DR. HEBA BOSHRA
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Credential | MD
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Telephone | 909-226-0198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A120531
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License Number State | CA
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