| Morongo Medical Group Inc | |
|
57725 29 Palms Hwy Ste 401 Yucca Valley CA 92284-3044 | |
| (760) 228-1929 | |
| (760) 228-9633 |
| Full Name | Morongo Medical Group Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 57725 29 Palms Hwy, Yucca Valley, California |
| Authorized Official Name and Position | Prem P Salhotra (PRESIDENT) |
| Authorized Official Contact | 7602281929 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Morongo Medical Group Inc Po Box 1809 Yucca Valley CA 92286-1809 Ph: (760) 228-1929 | Morongo Medical Group Inc 57725 29 Palms Hwy Ste 401 Yucca Valley CA 92284-3044 Ph: (760) 228-1929 |
| NPI Number | 1972644516 |
|---|---|
| Provider Enumeration Date | 02/08/2007 |
| Last Update Date | 01/29/2021 |
| Medicare PECOS PAC ID | 6204829245 |
|---|---|
| Medicare Enrollment ID | O20040406000905 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972644516 | NPI | - | NPPES |
| GR0078500 | Medicaid | CA | |
| CE7451 | Other | CA | RAILROAD GROUP NO |
| ZZ53804AZ | Other | CA | BLUE SHIELD OF CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A426710 (California) | Primary |
| Provider Name | Prem P Salhotra |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457302812 PECOS PAC ID: 6800846346 Enrollment ID: I20050128000348 |
| Provider Name | Mi La Kim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295047058 PECOS PAC ID: 6305161563 Enrollment ID: I20150210000868 |
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