Provider Demographics
NPI:1710264205
Name:PELAYO, MARLON DONASCO (RD)
Entity Type:Individual
Prefix:MR
First Name:MARLON
Middle Name:DONASCO
Last Name:PELAYO
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5859 CANDLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-1828
Mailing Address - Country:US
Mailing Address - Phone:773-490-0118
Mailing Address - Fax:
Practice Address - Street 1:5859 CANDLEWOOD ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-1828
Practice Address - Country:US
Practice Address - Phone:773-490-0118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL957332133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered