Basic Information
| Provider Information | |||||||||
| NPI: | 1093174260 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANOUSHEH ASHOURI INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6926 BROCKTON AVE STE 8 | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925063804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8774147739 | ||||||||
| FaxNumber: | 8446820372 | ||||||||
| Practice Location | |||||||||
| Address1: | 9440 CITRUS AVE | ||||||||
| Address2: | |||||||||
| City: | FONTANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923355512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098233481 | ||||||||
| FaxNumber: | 9093638629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2016 | ||||||||
| LastUpdateDate: | 11/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | ASHOURI | ||||||||
| AuthorizedOfficialFirstName: | ANOUSHEH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6304424206 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 11/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A113709 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.