Healthcare Provider Details

I. General information

NPI: 1235115015
Provider Name (Legal Business Name): SAMANTHA ANN MONGAR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA ANN MONGAR-KRAM DO

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/29/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 BIRCH STREET
LAKE ISABELLA CA
93240
US

IV. Provider business mailing address

PO BOX 1628
LAKE ISABELLA CA
93240-1628
US

V. Phone/Fax

Practice location:
  • Phone: 760-379-1791
  • Fax: 760-379-1793
Mailing address:
  • Phone: 760-379-1791
  • Fax: 760-379-2321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number20A10029
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: