Provider Demographics
NPI:1659732881
Name:PELAYO, LETICIA (ATC)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:PELAYO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68605 CORRAL RD APT 30E
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-4156
Mailing Address - Country:US
Mailing Address - Phone:818-746-6071
Mailing Address - Fax:
Practice Address - Street 1:68605 CORRAL RD APT 30E
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-4156
Practice Address - Country:US
Practice Address - Phone:818-746-6071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer