Provider Demographics
NPI:1184632226
Name:STEVE S. OBEREMOK, M.D., INC
Entity Type:Organization
Organization Name:STEVE S. OBEREMOK, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:S
Authorized Official - Last Name:OBEREMOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-658-9461
Mailing Address - Street 1:720 E LATHAM AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4371
Mailing Address - Country:US
Mailing Address - Phone:951-658-9461
Mailing Address - Fax:951-652-7103
Practice Address - Street 1:720 E LATHAM AVE STE 1
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4371
Practice Address - Country:US
Practice Address - Phone:951-658-9461
Practice Address - Fax:951-652-7103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23306174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G233060Medicaid
CA1942245873OtherINDIVIDUAL NPI #
CAZZZ01565ZMedicare ID - Type Unspecified
CAA41908Medicare UPIN
CA1942245873OtherINDIVIDUAL NPI #