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General NPI Number Information
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NPI Number | 1427595412
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Entity Type | Organization
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Legal Business Name | HI-DESERT FAMILY MEDICAL CLINIC
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Dates
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Enumeration Date | 01/27/2017
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 7350 CHURCH ST
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-3246
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Country | US
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Telephone | 760-369-3069
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Fax |
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Provider Business Mailing Address
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Address Line | 7350 CHURCH ST
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-3246
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Country | US
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Telephone | 760-369-3069
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDRE KASKO
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Credential | D.O.
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Telephone | 760-366-7555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State | CA
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