Provider Demographics
NPI:1972068989
Name:PELAYO, SUSANA
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:PELAYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4275 COMMERCIAL ST SE STE 180
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4087
Mailing Address - Country:US
Mailing Address - Phone:503-983-3348
Mailing Address - Fax:
Practice Address - Street 1:4275 COMMERCIAL ST SE STE 180
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4087
Practice Address - Country:US
Practice Address - Phone:503-983-3348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR6233874OtherOREGON ID