Provider Demographics
NPI:1538545017
Name:GOOD SAMARITAN HOSPITAL CA LTD PTP
Entity type:Organization
Organization Name:GOOD SAMARITAN HOSPITAL CA LTD PTP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGELIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MONZON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:661-241-5509
Mailing Address - Street 1:5201 WHITE LN
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-6200
Mailing Address - Country:US
Mailing Address - Phone:661-398-1800
Mailing Address - Fax:661-837-0755
Practice Address - Street 1:5201 WHITE LN
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-6200
Practice Address - Country:US
Practice Address - Phone:661-398-1800
Practice Address - Fax:661-837-0755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120000146283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050257Medicare Oscar/Certification