Basic Information
| Provider Information | |||||||||
| NPI: | 1811168917 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOBOVIC | ||||||||
| FirstName: | MARA | ||||||||
| MiddleName: | SIMONE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5601 DE SOTO AVE | ||||||||
| Address2: | NORTHSIDE BUILDING E224B | ||||||||
| City: | WOODLAND HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913676701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187192000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5601 DE SOTO AVE | ||||||||
| Address2: | NORTHSIDE BUILDING E224B | ||||||||
| City: | WOODLAND HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913676701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187192000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2008 | ||||||||
| LastUpdateDate: | 11/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A107842 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.