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NPI Code Detail

MEDICARE: DR. MEL CLARK REQUIAS TAVEROS M.D.

MEDICARE: DR. MEL CLARK REQUIAS TAVEROS M.D.
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
1208000000XPediatrics PhysicianA139158CA

General Provider Information

NPI Number : 1982973582
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MEL CLARK REQUIAS TAVEROS M.D.
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 : 661-635-3070
Provider Business Practice Location Address
First Line : 301 BRUNDAGE LN
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93304-3248
Country : US
Telephone Number : 661-323-6086
Fax Number : 661-324-6301
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2011
Last Update Date : 12/15/2015

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