MEDICARE: ZAKARIA BOSHRA, MD INC.

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	208D00000X	General Practice Physician	A51439	CA

General Provider Information

NPI Number	:	1891957460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZAKARIA BOSHRA, MD INC.

Provider Business Mailing Address
First Line	:	11755 VICTORY BLVD STE 202
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3423
Country	:	US
Telephone Number	:	562-650-2466
Fax Number	:

Provider Business Practice Location Address
First Line	:	11755 VICTORY BLVD STE 202
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3423
Country	:	US
Telephone Number	:	562-650-2466
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ZAKARIA TAKY BOSHRA
Credential	:	M.D.
Telephone Number	:	562-650-2466

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	06/25/2008

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