Healthcare Provider Details

I. General information

NPI: 1619365780
Provider Name (Legal Business Name): MELITON V. PALLARES JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2014
Last Update Date: 12/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2042 KERN ST
FRESNO CA
93721-2008
US

IV. Provider business mailing address

5067 N BUNGALOW LN
FRESNO CA
93704-2602
US

V. Phone/Fax

Practice location:
  • Phone: 559-400-6420
  • Fax:
Mailing address:
  • Phone: 559-400-9332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number829847
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: