Provider Demographics
NPI:1811365208
Name:BOURI, AMINE
Entity type:Individual
Prefix:
First Name:AMINE
Middle Name:
Last Name:BOURI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11532 WESTWOOD BLVD APT 615
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-7398
Mailing Address - Country:US
Mailing Address - Phone:321-946-3584
Mailing Address - Fax:
Practice Address - Street 1:10156 LOVE STORY ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-1758
Practice Address - Country:US
Practice Address - Phone:321-946-3584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
FL0363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical