Provider Demographics
NPI:1568908606
Name:PELAYO, IVETTE ROCHIN
Entity Type:Individual
Prefix:MS
First Name:IVETTE
Middle Name:ROCHIN
Last Name:PELAYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11226 TAMARACK AVE
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-2734
Mailing Address - Country:US
Mailing Address - Phone:818-653-2253
Mailing Address - Fax:
Practice Address - Street 1:11226 TAMARACK AVE
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-2734
Practice Address - Country:US
Practice Address - Phone:818-653-2253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112535106H00000X
CA131252106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist