Provider Demographics
NPI:1942463161
Name:PETOT, MELVIN F (REGISTERED NURSE)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:F
Last Name:PETOT
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23402 VIA FARALLON
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-3046
Mailing Address - Country:US
Mailing Address - Phone:661-255-8882
Mailing Address - Fax:661-255-8882
Practice Address - Street 1:23402 VIA FARALLON
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-3046
Practice Address - Country:US
Practice Address - Phone:661-255-8882
Practice Address - Fax:661-255-8882
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN228954163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse