Provider Demographics
NPI:1073378840
Name:PELAYO, VALERIA ALEJANDRA (MA, EDS)
Entity Type:Individual
Prefix:
First Name:VALERIA
Middle Name:ALEJANDRA
Last Name:PELAYO
Suffix:
Gender:F
Credentials:MA, EDS
Other - Prefix:
Other - First Name:VALERIA
Other - Middle Name:ALEJANDRA
Other - Last Name:LARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAA, EDS
Mailing Address - Street 1:69310 MCCALLUM WAY
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-2997
Mailing Address - Country:US
Mailing Address - Phone:760-770-8635
Mailing Address - Fax:
Practice Address - Street 1:69310 MCCALLUM WAY
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-2997
Practice Address - Country:US
Practice Address - Phone:760-770-8635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool