Healthcare Provider Details

I. General information

NPI: 1427595412
Provider Name (Legal Business Name): HI-DESERT FAMILY MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 CHURCH ST
YUCCA VALLEY CA
92284-3246
US

IV. Provider business mailing address

7350 CHURCH ST
YUCCA VALLEY CA
92284-3246
US

V. Phone/Fax

Practice location:
  • Phone: 760-369-3069
  • Fax:
Mailing address:
  • Phone: 760-369-3069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. ANDRE KASKO
Title or Position: OWNER
Credential: D.O.
Phone: 760-366-7555