Provider Demographics
NPI:1992031306
Name:PELAYO, GILBERT (FNP)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:
Last Name:PELAYO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38780 TRADE CENTER DR
Mailing Address - Street 2:# 1C
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3641
Mailing Address - Country:US
Mailing Address - Phone:661-947-5600
Mailing Address - Fax:800-890-6055
Practice Address - Street 1:38780 TRADE CENTER DR
Practice Address - Street 2:# 1C
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3641
Practice Address - Country:US
Practice Address - Phone:661-947-5600
Practice Address - Fax:800-890-6055
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19283363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP70436FMedicaid
CAEAP70436FMedicaid
CAFHC70436FMedicaid
CAW11698OtherGROUP ID
CAEAP70436FMedicaid