Provider Demographics
NPI:1003392838
Name:PELAEZ, GABRIEL (PA-C)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:PELAEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2852 SW 132ND PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7115
Mailing Address - Country:US
Mailing Address - Phone:610-945-7950
Mailing Address - Fax:
Practice Address - Street 1:2000 FOULK RD STE F
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3642
Practice Address - Country:US
Practice Address - Phone:302-652-8990
Practice Address - Fax:302-652-8646
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111165363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant