| Organization Name: | MORONGO BASIN OB/GYN MEDICAL GROUP INC |
| NPI Number: | 1629392675 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANDRE MARTIN KASKO (CEO) |
| Mailing Address: | 63532 29 Palms Hwy Ste#d Joshua Tree |
| State: | CA US |
| Postal Code: | 922520810 |
| Phone Number: | 7603661800 |
| Fax Number: | 7603662155 |
| NPI Enumeration Date: | 03/19/2010 |
| NPI Last Update Date: | 03/19/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207VG0400X |
| License Number: | 20A6300 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | Gynecology |
| Taxonomy Definition: | |