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General NPI Number Information
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NPI Number | 1972644516
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Entity Type | Organization
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Legal Business Name | MORONGO MEDICAL GROUP INC
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 01/29/2021
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Provider Practice Location Address
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Address Line | 57725 29 PALMS HWY STE 401
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-3044
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Country | US
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Telephone | 760-228-1929
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Fax | 760-228-9633
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Provider Business Mailing Address
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Address Line | PO BOX 1809
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City | YUCCA VALLEY
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State | CA
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Zip | 92286-1809
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Country | US
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Telephone | 760-228-1929
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Fax | 760-228-9633
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PREM P SALHOTRA
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Credential | MD
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Telephone | 760-228-1929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A426710
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License Number State | CA
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