Provider Demographics
NPI:1386480606
Name:PELAYO, JUAN JR
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:PELAYO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 GAIL ST APT 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-1057
Mailing Address - Country:US
Mailing Address - Phone:323-636-9361
Mailing Address - Fax:
Practice Address - Street 1:236 W MOUNTAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-2968
Practice Address - Country:US
Practice Address - Phone:323-924-9084
Practice Address - Fax:213-723-2087
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker