Provider Demographics
NPI:1922440684
Name:TOBIAS MOELLER-BERTRAM MD CORPORATION
Entity type:Organization
Organization Name:TOBIAS MOELLER-BERTRAM MD CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOBIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOELLER-BERTRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-285-3755
Mailing Address - Street 1:44630 MONTEREY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3326
Mailing Address - Country:US
Mailing Address - Phone:800-285-3755
Mailing Address - Fax:760-406-6073
Practice Address - Street 1:36101 BOB HOPE DR STE A1
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2002
Practice Address - Country:US
Practice Address - Phone:760-321-1315
Practice Address - Fax:760-321-1094
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOBIAS MOELLER-BERTRAM MD CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-23
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD16880207LP2900X
CAA80383207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI49789Medicare UPIN
CAWA80383AMedicare PIN