Provider Demographics
NPI:1033319173
Name:GHOBRIAL, MONA M (MD)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:M
Last Name:GHOBRIAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17332 VON KARMAN AVE STE 110A
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6242
Mailing Address - Country:US
Mailing Address - Phone:858-314-9222
Mailing Address - Fax:949-864-2320
Practice Address - Street 1:7625 MESA COLLEGE DR STE 250A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-5343
Practice Address - Country:US
Practice Address - Phone:858-314-9222
Practice Address - Fax:949-864-2320
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-01197207Q00000X
CAA116629207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A1166290Medicaid
CAFI926ZMedicare PIN