Healthcare Provider Details

I. General information

NPI: 1538285697
Provider Name (Legal Business Name): TEHACHAPI MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 11/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W TEHACHAPI BLVD SUITE A-100
TEHACHAPI CA
93561-2532
US

IV. Provider business mailing address

PO BOX 2525
TEHACHAPI CA
93581-2525
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-2530
  • Fax: 661-822-2536
Mailing address:
  • Phone: 661-822-2530
  • Fax: 661-822-2536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A5732
License Number StateCA

VIII. Authorized Official

Name: DR. MARK ALAN PESCHE
Title or Position: PRESIDENT
Credential: D.O,
Phone: 661-822-2530