Provider Demographics
NPI:1861524506
Name:GOKA, RICHARD S (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:GOKA
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:PO BOX 14089
Mailing Address - Street 2:
Mailing Address - City:PINEDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93650
Mailing Address - Country:US
Mailing Address - Phone:559-269-2003
Mailing Address - Fax:559-439-3212
Practice Address - Street 1:7339 N 1ST ST
Practice Address - Street 2:#105
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2954
Practice Address - Country:US
Practice Address - Phone:559-269-2003
Practice Address - Fax:229-439-3212
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36256208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
19035500OtherUS DEPT OF LABOR
19035500OtherUS DEPT OF LABOR
C63459Medicare UPIN