Healthcare Provider Details

I. General information

NPI: 1003689324
Provider Name (Legal Business Name): JEAN-PIERRE PETREL II PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3012 S DURANGO DR
LAS VEGAS NV
89117-9186
US

IV. Provider business mailing address

951 LAS PALMAS ENTRADA AVE APT 1613
HENDERSON NV
89012-5623
US

V. Phone/Fax

Practice location:
  • Phone: 702-901-4233
  • Fax:
Mailing address:
  • Phone: 702-499-9972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA2931
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2931
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2931
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: