Healthcare Provider Details

I. General information

NPI: 1427488006
Provider Name (Legal Business Name): TOBIAS MOELLER-BERTRAM, M.D CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81812 DR CARREON BLVD SUITE D
INDIO CA
92201-0607
US

IV. Provider business mailing address

3857 BIRCH ST. SUITE 605
NEWPORT BEACH CA
92660
US

V. Phone/Fax

Practice location:
  • Phone: 760-347-7676
  • Fax:
Mailing address:
  • Phone: 949-786-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA80383
License Number StateCA

VIII. Authorized Official

Name: MS. HEATHER MCDONALD MCDONALD
Title or Position: ADMINSITRATOR
Credential:
Phone: 949-783-3600