Provider Demographics
NPI:1487770459
Name:COUNTY OF MONO
Entity type:Organization
Organization Name:COUNTY OF MONO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOBERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-932-5414
Mailing Address - Street 1:PO BOX 476
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:93517-0476
Mailing Address - Country:US
Mailing Address - Phone:760-932-5580
Mailing Address - Fax:760-932-5284
Practice Address - Street 1:1290 TAVERN RD STE 246
Practice Address - Street 2:
Practice Address - City:MAMMOTH LAKES
Practice Address - State:CA
Practice Address - Zip Code:93546-6603
Practice Address - Country:US
Practice Address - Phone:760-924-1830
Practice Address - Fax:760-924-1831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29565ZMedicare ID - Type UnspecifiedBRIDGEPORT CLINIC
CAZZZ29566ZMedicare ID - Type UnspecifiedML CLINICS