Basic Information
| Provider Information | |||||||||
| NPI: | 1487688339 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COBANOGLU | ||||||||
| FirstName: | MUSTAFA | ||||||||
| MiddleName: | ADNAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | LOMA LINDA UNIVERSITY | ||||||||
| Address2: | 11175 CAMPUS STREET SUITE 21123 | ||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923542741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095584354 | ||||||||
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| Practice Location | |||||||||
| Address1: | LOMA LINDA UNIVERSITY | ||||||||
| Address2: | 11175 CAMPUS STREET SUITE 21123 | ||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923542741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095584354 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 10/17/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 35-087458 | OH | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 000000221079 | 01 | UNISON | OTHER | 000000503670 | 01 | ANTHEM | OTHER | 2638793 | 05 | OH | MEDICAID | 741756 | 01 | BUCKEYE | OTHER | 363430 | 01 | WELLCARE | OTHER | 7818813 | 01 | AETNA | OTHER |