Healthcare Provider Details

I. General information

NPI: 1295690535
Provider Name (Legal Business Name): ROBERT HOBERG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 12455
ALBUQUERQUE NM
87195-0455
US

IV. Provider business mailing address

1317 ISLETA BLVD SW
ALBUQUERQUE NM
87105-4035
US

V. Phone/Fax

Practice location:
  • Phone: 505-312-7296
  • Fax: 505-554-1620
Mailing address:
  • Phone: 505-312-7296
  • Fax: 505-554-1620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: