Provider Demographics
NPI:1235115015
Name:MONGAR, SAMANTHA ANN (DO)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:ANN
Last Name:MONGAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:ANN
Other - Last Name:MONGAR-KRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 1628
Mailing Address - Street 2:
Mailing Address - City:LAKE ISABELLA
Mailing Address - State:CA
Mailing Address - Zip Code:93240-1628
Mailing Address - Country:US
Mailing Address - Phone:760-379-1791
Mailing Address - Fax:760-379-2321
Practice Address - Street 1:4300 BIRCH STREET
Practice Address - Street 2:
Practice Address - City:LAKE ISABELLA
Practice Address - State:CA
Practice Address - Zip Code:93240
Practice Address - Country:US
Practice Address - Phone:760-379-1791
Practice Address - Fax:760-379-1793
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10029207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine