Provider Demographics
NPI:1255511630
Name:FAMILY HEALTH CENTER OF JOSHUA TREE INCORPORATED
Entity type:Organization
Organization Name:FAMILY HEALTH CENTER OF JOSHUA TREE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:KASKO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:760-365-2800
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:760-366-7555
Mailing Address - Fax:760-366-0529
Practice Address - Street 1:57445 29 PALMS HWY STE 302
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2947
Practice Address - Country:US
Practice Address - Phone:760-366-7555
Practice Address - Fax:760-366-0529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA200A6300OtherLICENSE
CA4630338Medicaid