Provider Demographics
NPI:1033673884
Name:OBERMAN, HAROLD IVAN
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:IVAN
Last Name:OBERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 BLUE SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-8701
Mailing Address - Country:US
Mailing Address - Phone:951-766-6648
Mailing Address - Fax:951-766-6648
Practice Address - Street 1:2721 BLUE SPRUCE DR
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-8701
Practice Address - Country:US
Practice Address - Phone:951-766-6648
Practice Address - Fax:951-276-6664
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN3760526172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver