Provider Demographics
NPI:1306094008
Name:PELAYO-KATSANIS, LUZ OLGA (CPNP)
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:OLGA
Last Name:PELAYO-KATSANIS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:LUZ
Other - Middle Name:O
Other - Last Name:DURANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:2701 E ELVIRA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-7124
Mailing Address - Country:US
Mailing Address - Phone:520-874-3500
Mailing Address - Fax:
Practice Address - Street 1:1501 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-0001
Practice Address - Country:US
Practice Address - Phone:520-694-7433
Practice Address - Fax:520-694-6688
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3093363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ373254Medicaid
AZZ124794Medicare PIN