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General NPI Number Information
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NPI Number | 1396923579
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Entity Type | Individual
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Provider Name | JENNIFER COBANOV M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/09/2008
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 414 TENNESSEE ST STE K1
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City | REDLANDS
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State | CA
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Zip | 92373-8152
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Country | US
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Telephone | 909-531-4427
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Fax | 909-288-4731
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Provider Business Mailing Address
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Address Line | PO BOX 902
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City | LOMA LINDA
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State | CA
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Zip | 92354-0902
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Country | US
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Telephone | 909-647-8783
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A108683
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License Number State | CA
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