| Habib Moussa Bashoura Md Inc | |
|
1234 Foothill Blvd La Verne CA 91750 | |
| (909) 596-4879 | |
| (909) 596-6612 |
| Full Name | Habib Moussa Bashoura Md Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1234 Foothill Blvd, La Verne, California |
| Authorized Official Name and Position | Habib Bashoura (PHYSICIAN) |
| Authorized Official Contact | 9095964879 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Habib Moussa Bashoura Md Inc 1234 Foothill Blvd La Verne CA 91750 Ph: (909) 596-4879 | Habib Moussa Bashoura Md Inc 1234 Foothill Blvd La Verne CA 91750 Ph: (909) 596-4879 |
| NPI Number | 1609952431 |
|---|---|
| Provider Enumeration Date | 10/27/2006 |
| Last Update Date | 12/15/2016 |
| Medicare PECOS PAC ID | 6507923091 |
|---|---|
| Medicare Enrollment ID | O20090327000339 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609952431 | NPI | - | NPPES |
| 00A525191 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Habib M Bashoura |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730170887 PECOS PAC ID: 7012093768 Enrollment ID: I20090327000333 |
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