Provider Demographics
NPI:1932246709
Name:MICHAEL R OBERTO MD INC
Entity Type:Organization
Organization Name:MICHAEL R OBERTO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:OBERTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-432-2600
Mailing Address - Street 1:7235 N 1ST ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2964
Mailing Address - Country:US
Mailing Address - Phone:559-432-2600
Mailing Address - Fax:559-432-3025
Practice Address - Street 1:7235 N 1ST ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2964
Practice Address - Country:US
Practice Address - Phone:559-432-2600
Practice Address - Fax:559-432-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48166174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9117618Medicaid
CA199870400OtherUSDL
CA200004120OtherRAILROAD MEDICARE
CA9117618Medicaid
CA0818800001Medicare NSC