Provider Demographics
NPI:1063684546
Name:PELAEZ, EVANGELINE BAQUIRAN (ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:EVANGELINE
Middle Name:BAQUIRAN
Last Name:PELAEZ
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3816 LOS OLIVOS LN
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1626
Mailing Address - Country:US
Mailing Address - Phone:818-929-4066
Mailing Address - Fax:
Practice Address - Street 1:100 N BARRANCA ST STE 900
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1662
Practice Address - Country:US
Practice Address - Phone:626-206-0523
Practice Address - Fax:626-206-0553
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA560404363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health