Provider Demographics
NPI:1891212296
Name:HEBA BOSHRA MD, INC.
Entity Type:Organization
Organization Name:HEBA BOSHRA MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:HEBA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSHRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-226-0198
Mailing Address - Street 1:6971 RUSSIAN RIVER CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2063
Mailing Address - Country:US
Mailing Address - Phone:909-226-0198
Mailing Address - Fax:
Practice Address - Street 1:5900 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-1862
Practice Address - Country:US
Practice Address - Phone:909-226-0198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA120531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty