Provider Demographics
NPI:1285059170
Name:GHOBRIAL, MINA (DO)
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:GHOBRIAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5398 PARK ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-1041
Mailing Address - Country:US
Mailing Address - Phone:727-544-1441
Mailing Address - Fax:727-545-8263
Practice Address - Street 1:5398 PARK ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-1041
Practice Address - Country:US
Practice Address - Phone:727-544-1441
Practice Address - Fax:727-545-8263
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA283883207RC0001X
390200000X
FLOS18622207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program