Healthcare Provider Details

I. General information

NPI: 1629947874
Provider Name (Legal Business Name): CLARE MCKINDLEY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 S GREEN ST STE 5
TEHACHAPI CA
93561-1763
US

IV. Provider business mailing address

PO BOX 1133
TEHACHAPI CA
93581-1133
US

V. Phone/Fax

Practice location:
  • Phone: 661-750-2655
  • Fax:
Mailing address:
  • Phone: 661-750-2655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number963954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: