Provider Demographics
NPI:1528293909
Name:ERNESTINA PELAYO DE OLIVARES MD PLLC
Entity type:Organization
Organization Name:ERNESTINA PELAYO DE OLIVARES MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PELAYO DE OLIVARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-742-9166
Mailing Address - Street 1:5425 N ORACLE RD STE 115
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3898
Mailing Address - Country:US
Mailing Address - Phone:520-742-9166
Mailing Address - Fax:520-742-9146
Practice Address - Street 1:5425 N ORACLE RD STE 115
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3898
Practice Address - Country:US
Practice Address - Phone:520-742-9166
Practice Address - Fax:520-742-9146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31109251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health