Provider Demographics
NPI:1629290432
Name:ZELAYA-PEO, JAZMIN JULIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAZMIN
Middle Name:JULIA
Last Name:ZELAYA-PEO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 EAST COTATI AVENUE
Mailing Address - Street 2:
Mailing Address - City:COTATI
Mailing Address - State:CA
Mailing Address - Zip Code:94931
Mailing Address - Country:US
Mailing Address - Phone:707-664-1200
Mailing Address - Fax:707-664-1206
Practice Address - Street 1:421 EAST COTATI AVENUE
Practice Address - Street 2:
Practice Address - City:COTATI
Practice Address - State:CA
Practice Address - Zip Code:94931
Practice Address - Country:US
Practice Address - Phone:707-664-1200
Practice Address - Fax:707-664-1206
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA421041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice