MEDICARE: TOBIAS MOELLER-BERTRAM MD CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	A80383	CA

General Provider Information

NPI Number	:	1922440684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOBIAS MOELLER-BERTRAM MD CORPORATION

Provider Business Mailing Address
First Line	:	44630 MONTEREY AVE STE 100
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3326
Country	:	US
Telephone Number	:	800-285-3755
Fax Number	:	760-406-6073

Provider Business Practice Location Address
First Line	:	36101 BOB HOPE DR STE A1
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-2002
Country	:	US
Telephone Number	:	760-321-1315
Fax Number	:	760-321-1094

Authorized Official
Title or Position	:	CFO
Name	:	MICHAEL VON KOLEN
Credential	:
Telephone Number	:	800-285-3755

Provider Enumeration Date	:	07/23/2013
Last Update Date	:	01/30/2026

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