Provider Demographics
NPI:1932726148
Name:PROFEIT, JOHN SCOTT (EMT-P)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SCOTT
Last Name:PROFEIT
Suffix:
Gender:M
Credentials:EMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 ST REGIS AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-7017
Mailing Address - Country:US
Mailing Address - Phone:925-285-7914
Mailing Address - Fax:
Practice Address - Street 1:2675 ST REGIS AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-7017
Practice Address - Country:US
Practice Address - Phone:925-285-7914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAP06680146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic