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Individual
JOHN ERIC MELLOTT
Active
Individual
JOHN ERIC MELLOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA16897
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA16897
—
CA
Enumeration date
07/07/2006
Last updated
06/27/2008
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