Provider Demographics
NPI:1679624191
Name:KASKO, ANDRE MARTIN (DO)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:MARTIN
Last Name:KASKO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1220
Mailing Address - Street 2:
Mailing Address - City:JOSHUA TREE
Mailing Address - State:CA
Mailing Address - Zip Code:92252-0810
Mailing Address - Country:US
Mailing Address - Phone:760-365-2800
Mailing Address - Fax:760-365-1406
Practice Address - Street 1:57445 29 PALMS HWY
Practice Address - Street 2:SUITE 301
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2947
Practice Address - Country:US
Practice Address - Phone:760-365-2800
Practice Address - Fax:760-365-1406
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6300207VX0000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX63000Medicaid
CA207V00000XMedicaid
CA207VG0400XMedicaid