Basic Information
| Provider Information | |||||||||
| NPI: | 1003902164 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOBRINE | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 COFFEE RD | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953554201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095241211 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1015 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | TURLOCK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953803406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2096323901 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 12/06/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 8735 | MT | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | C53606 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | C53606 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0019091 | 01 | MT | MDCD PIN | OTHER | 114673400 | 01 | WY | MDCD PIN | OTHER | 000000823 | 01 | MT | BCBS PIN | OTHER |