Healthcare Provider Details

I. General information

NPI: 1013205806
Provider Name (Legal Business Name): DR ROLAND A GASKINS DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 03/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23025 ATLANTIC CIR SUITE C
MORENO VALLEY CA
92553-5909
US

IV. Provider business mailing address

PO BOX 7903
MORENO VALLEY CA
92552-7903
US

V. Phone/Fax

Practice location:
  • Phone: 951-486-8618
  • Fax: 951-486-9018
Mailing address:
  • Phone: 951-486-8618
  • Fax: 951-486-9018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE3646
License Number StateCA

VIII. Authorized Official

Name: DR. ROLAND ANDRE GASKINS
Title or Position: OWNER
Credential: D.P.M
Phone: 951-486-8618