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NPI Code Detail

MEDICARE: CLINICA SIERRA VISTA

MEDICARE: CLINICA SIERRA VISTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)CA

General Provider Information

NPI Number : 1336544790
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLINICA SIERRA VISTA
Provider Business Mailing Address
First Line : PO BOX 1559
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93302-1559
Country : US
Telephone Number : 661-635-3050
Fax Number : 661-732-3064
Provider Business Practice Location Address
First Line : 301 BRUNDAGE LN
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93304-3248
Country : US
Telephone Number : 661-635-3050
Fax Number :
Authorized Official
Title or Position : CEO
Name : OLGA MEAVE
Credential :
Telephone Number : 661-635-3050
Provider Enumeration Date : 10/28/2014
Last Update Date : 02/09/2024

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1982973582 — DR. MEL CLARK REQUIAS TAVEROS M.D.
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Directions to “CLINICA SIERRA VISTA ” Practice Location

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