1992031306 NPI number — GILBERT PELAYO F.N.P

Table of content: GILBERT PELAYO F.N.P (NPI 1992031306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992031306 NPI number — GILBERT PELAYO F.N.P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PELAYO
Provider First Name:
GILBERT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
F.N.P
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992031306
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38780 TRADE CENTER DR
Provider Second Line Business Mailing Address:
# 1C
Provider Business Mailing Address City Name:
PALMDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93551-3641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-947-5600
Provider Business Mailing Address Fax Number:
800-890-6055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38780 TRADE CENTER DR
Provider Second Line Business Practice Location Address:
# 1C
Provider Business Practice Location Address City Name:
PALMDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93551-3641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-947-5600
Provider Business Practice Location Address Fax Number:
800-890-6055
Provider Enumeration Date:
10/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  19283 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HAP70436F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: EAP70436F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: FHC70436F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W11698 . This is a "GROUP ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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