Healthcare Provider Details

I. General information

NPI: 1538456215
Provider Name (Legal Business Name): STEVE OBEREMOK M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28780 SINGLE OAK DR SUITE 160
TEMECULA CA
92590-3625
US

IV. Provider business mailing address

28780 SINGLE OAK DR SUITE 160
TEMECULA CA
92590-3625
US

V. Phone/Fax

Practice location:
  • Phone: 951-658-9461
  • Fax:
Mailing address:
  • Phone: 951-658-9461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA86584
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA86584
License Number StateCA

VIII. Authorized Official

Name: STEVE OBEREMOK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 951-658-9461