Healthcare Provider Details

I. General information

NPI: 1699586388
Provider Name (Legal Business Name): MOELLER-BERTRAM MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 03/02/2025
Certification Date: 03/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36101 BOB HOPE DR STE A1
RANCHO MIRAGE CA
92270-2002
US

IV. Provider business mailing address

44630 MONTEREY AVE STE 100
PALM DESERT CA
92260-3326
US

V. Phone/Fax

Practice location:
  • Phone: 760-321-1315
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TOBIAS MOELLER-BERTRAM
Title or Position: PRESIDENT
Credential: MD
Phone: 800-285-3755