Organization
MOUNTAIN MEADOWS MEDICAL GROUP OF CALIFORNIA, INC.
Active
Other names
Tahoe Women's Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KRIS F KOBALTER MD (VICE PRESIDENT)
(530) 543-5710
Entity
Organization
Contact information
Practice address
1067 4TH ST, S LAKE TAHOE, CA 96150-3459
(530) 543-5710
(530) 542-1455
Mailing address
1067 4TH ST, S LAKE TAHOE, CA 96150-3459
(530) 543-5710
(530) 542-1455
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
207V00000X
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0023700
—
CA
Enumeration date
02/28/2007
Last updated
09/19/2012
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