Healthcare Provider Details

I. General information

NPI: 1114477106
Provider Name (Legal Business Name): TOBIAS MOELLER-BERTRAM, MD CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36101 BOB HOPE DR SUITE B-2
RANCHO MIRAGE CA
92270-2001
US

IV. Provider business mailing address

3857 BIRCH ST #605
NEWPORT BEACH CA
92660-2616
US

V. Phone/Fax

Practice location:
  • Phone: 760-321-1315
  • Fax: 760-321-1094
Mailing address:
  • Phone: 949-783-3600
  • Fax: 949-783-3602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number819
License Number StateCA

VIII. Authorized Official

Name: HEATHER MCDONALD
Title or Position: MANAGER
Credential:
Phone: 949-783-3600