Provider Demographics
NPI:1710910872
Name:GASKINS, ROLAND A (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:A
Last Name:GASKINS
Suffix:
Gender:M
Credentials:DPM
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 7903
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92552-7903
Mailing Address - Country:US
Mailing Address - Phone:951-486-8618
Mailing Address - Fax:951-486-9018
Practice Address - Street 1:23025 ATLANTIC CIR
Practice Address - Street 2:SUITE C
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5909
Practice Address - Country:US
Practice Address - Phone:951-486-8618
Practice Address - Fax:951-486-9018
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3646213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0732624Medicaid
FU707ZMedicare PIN
CA0732624Medicaid
CA5046970001Medicare NSC