Healthcare Provider Details

I. General information

NPI: 1588914154
Provider Name (Legal Business Name): FRED KOBER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 N EASTERN AVE SUITE 110
LAS VEGAS NV
89101-2883
US

IV. Provider business mailing address

9145 CEDENO ST
LAS VEGAS NV
89123-5318
US

V. Phone/Fax

Practice location:
  • Phone: 702-772-4864
  • Fax:
Mailing address:
  • Phone: 702-286-7354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: