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General NPI Number Information
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NPI Number | 1235115015
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Entity Type | Individual
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Provider Name | SAMANTHA ANN MONGAR DO
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Gender | Female
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 4300 BIRCH STREET
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City | LAKE ISABELLA
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State | CA
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Zip | 93240
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Country | US
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Telephone | 760-379-1791
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Fax | 760-379-1793
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Provider Business Mailing Address
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Address Line | PO BOX 1628
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City | LAKE ISABELLA
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State | CA
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Zip | 93240-1628
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Country | US
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Telephone | 760-379-1791
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Fax | 760-379-2321
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 20A10029
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License Number State | CA
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