Organization
MORONGO BASIN OB/GYN MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDRE MARTIN KASKO D.O. (CEO)
(760) 366-1800
Entity
Organization
Contact information
Practice address
63532 29 PALMS HWY, STE#D, JOSHUA TREE, CA 92252-0810
(760) 366-1800
(760) 366-2155
Mailing address
PO BOX 1220, JOSHUA TREE, CA 92252-0810
(760) 366-1800
(760) 366-2155
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
20A6300
CA
207VX0000X
Obstetrics Physician
Primary
20A6300
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20A6300
MEDICAL LICENSE
CA
Enumeration date
03/19/2010
Last updated
03/19/2010
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