Provider Demographics
NPI:1982973582
Name:TAVEROS, MEL CLARK REQUIAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MEL CLARK
Middle Name:REQUIAS
Last Name:TAVEROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1559
Mailing Address - Country:US
Mailing Address - Phone:661-635-3050
Mailing Address - Fax:661-635-3070
Practice Address - Street 1:301 BRUNDAGE LN
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-3248
Practice Address - Country:US
Practice Address - Phone:661-323-6086
Practice Address - Fax:661-324-6301
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA139158208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics