Provider Demographics
NPI:1184661506
Name:KASKA, SERGE CHARLES (MD)
Entity type:Individual
Prefix:
First Name:SERGE
Middle Name:CHARLES
Last Name:KASKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 RANCHEROS DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2976
Mailing Address - Country:US
Mailing Address - Phone:760-750-1902
Mailing Address - Fax:760-750-1908
Practice Address - Street 1:277 RANCHEROS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2976
Practice Address - Country:US
Practice Address - Phone:760-750-1902
Practice Address - Fax:760-750-1908
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2016-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73685174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A736850Medicaid
CA00A736850Medicaid
CAWA73685CMedicare PIN
CAW20526OtherMEDICARE PTAN