Provider Demographics
NPI:1619365780
Name:PALLARES, MELITON V JR (RN)
Entity Type:Individual
Prefix:MR
First Name:MELITON
Middle Name:V
Last Name:PALLARES
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5067 N BUNGALOW LN
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-2602
Mailing Address - Country:US
Mailing Address - Phone:559-400-9332
Mailing Address - Fax:
Practice Address - Street 1:2042 KERN ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-2008
Practice Address - Country:US
Practice Address - Phone:559-400-6420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-24
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA829847163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health