Provider Demographics
NPI:1073662748
Name:BOLOUR, SHEILA YAFAI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:YAFAI
Last Name:BOLOUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 17923
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-3923
Mailing Address - Country:US
Mailing Address - Phone:310-279-4649
Mailing Address - Fax:310-652-4902
Practice Address - Street 1:150 N ROBERTSON BLVD STE 222
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2144
Practice Address - Country:US
Practice Address - Phone:310-279-4649
Practice Address - Fax:310-652-4902
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75332207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA75332AMedicare ID - Type Unspecified
CAH96095Medicare UPIN