Healthcare Provider Details

I. General information

NPI: 1992705370
Provider Name (Legal Business Name): MORONGO BASIN OB/GYN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57445 29 PALMS HWY STE 301
YUCCA VALLEY CA
92284-2947
US

IV. Provider business mailing address

PO BOX 1220
JOSHUA TREE CA
92252-0810
US

V. Phone/Fax

Practice location:
  • Phone: 760-365-2800
  • Fax: 760-365-1406
Mailing address:
  • Phone: 760-365-2800
  • Fax: 760-365-1406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VC0200X
TaxonomyCritical Care Medicine (Obstetrics & Gynecology) Physician
License Number20A6300
License Number StateCA

VIII. Authorized Official

Name: ANDRE M KASKO
Title or Position: CEO
Credential: D.O.
Phone: 760-365-2800