MORONGO BASIN OB/GYN MEDICAL GROUP INC NPI 1629392675

NPI Information

MORONGO BASIN OB/GYN MEDICAL GROUP INC is an obstetrics obstetrics gynecology in Joshua Tree, CA. The provider is a physician who specializes in diagnosis, treatment, and management of patients with obstetric conditions. Source: National Uniform Claim Committee MORONGO BASIN OB/GYN MEDICAL GROUP INC NPI is 1629392675. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

63532 29 PALMS HWY
STE#D
JOSHUA TREE, CA
ZIP 92252-810
Phone: (760) 366-1800
Fax: (760) 366-2155

The provider's authorized official is Andre Martin Kasko .
The authorized official title is Ceo and has the following contact phone number (760) 366-1800.

The CLIA number assigned to this NPI record is 05D1029798 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/19/2010 and was last updated on 3/19/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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