Healthcare Provider Details

I. General information

NPI: 1164047262
Provider Name (Legal Business Name): MELINDA WHITACRE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 N MILL ST
TEHACHAPI CA
93561-1384
US

IV. Provider business mailing address

161 N MILL ST
TEHACHAPI CA
93561-1384
US

V. Phone/Fax

Practice location:
  • Phone: 866-707-6664
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA209967
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-54636
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: