Provider Demographics
NPI:1548867666
Name:AL-SHOUBAKI, HEBA MARZOUK (PA-C)
Entity type:Individual
Prefix:
First Name:HEBA
Middle Name:MARZOUK
Last Name:AL-SHOUBAKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 E CHAPMAN AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3204
Mailing Address - Country:US
Mailing Address - Phone:714-628-3230
Mailing Address - Fax:
Practice Address - Street 1:2501 E CHAPMAN AVE STE 306
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3204
Practice Address - Country:US
Practice Address - Phone:714-628-3230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA58597363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant