Provider Demographics
NPI:1568860179
Name:PELZ, MOLLY A
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:A
Last Name:PELZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:A
Other - Last Name:TRAUB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6340 IRVINE BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-2102
Mailing Address - Country:US
Mailing Address - Phone:949-559-6500
Mailing Address - Fax:
Practice Address - Street 1:6340 IRVINE BLVD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-2102
Practice Address - Country:US
Practice Address - Phone:949-559-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-12
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51666363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant