Provider Demographics
NPI:1396560249
Name:PELAEZ VERA, ISIUMY (SA-C)
Entity type:Individual
Prefix:
First Name:ISIUMY
Middle Name:
Last Name:PELAEZ VERA
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 NW 13TH ST APT 26
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2602
Mailing Address - Country:US
Mailing Address - Phone:786-635-4425
Mailing Address - Fax:
Practice Address - Street 1:604 NW 13TH ST APT 26
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2602
Practice Address - Country:US
Practice Address - Phone:786-635-4425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-508246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant