| |
7350 Church St Yucca Valley CA 92284-3246 | |
(760) 369-3069 | |
(760) 369-3072 |
Full Name | |
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Speciality | Family Medicine |
Location | 7350 Church St, Yucca Valley, California |
Authorized Official Name and Position | Andre Martin Kasko (PRESIDENT/CEO) |
Authorized Official Contact | 7603693069 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 1220 Joshua Tree CA 92252-0810 Ph: (760) 369-3069 | 7350 Church St Yucca Valley CA 92284-3246 Ph: (760) 369-3069 |
NPI Number | 1639405004 |
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Provider Enumeration Date | 10/20/2009 |
Last Update Date | 12/23/2024 |
Medicare PECOS PAC ID | 0648346007 |
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Medicare Enrollment ID | O20091210000140 |
Identifier | Type | State | Issuer |
---|---|---|---|
1639405004 | NPI | - | NPPES |
553845 | Other | CA | MEDICARE IDENTIFICATION NUMBER |
1867739 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
207V00000X | Obstetrics & Gynecology | (* (Not Available)) | Secondary |
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