Provider Demographics
NPI:1093174260
Name:ANOUSHEH ASHOURI INC
Entity Type:Organization
Organization Name:ANOUSHEH ASHOURI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANOUSHEH
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHOURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-442-4206
Mailing Address - Street 1:6926 BROCKTON AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3804
Mailing Address - Country:US
Mailing Address - Phone:877-414-7739
Mailing Address - Fax:844-682-0372
Practice Address - Street 1:9440 CITRUS AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-5512
Practice Address - Country:US
Practice Address - Phone:909-823-3481
Practice Address - Fax:909-363-8629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113709207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty