Provider Demographics
NPI:1639773013
Name:HARBA, BUSHRA
Entity Type:Individual
Prefix:
First Name:BUSHRA
Middle Name:
Last Name:HARBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1582 ELBUR AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4741
Mailing Address - Country:US
Mailing Address - Phone:216-496-7589
Mailing Address - Fax:603-654-3047
Practice Address - Street 1:1400 W PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-6720
Practice Address - Country:US
Practice Address - Phone:440-882-6595
Practice Address - Fax:603-654-3047
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty