Provider Demographics
NPI:1366537045
Name:GHEBRIAL, MINA S (MD)
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:S
Last Name:GHEBRIAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8945 MAGNOLIA AVE
Mailing Address - Street 2:SUITE #205
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-4436
Mailing Address - Country:US
Mailing Address - Phone:951-689-9220
Mailing Address - Fax:951-689-8377
Practice Address - Street 1:8945 MAGNOLIA AVE
Practice Address - Street 2:SUITE #205
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-4436
Practice Address - Country:US
Practice Address - Phone:951-689-9220
Practice Address - Fax:951-689-8377
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA60916208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics