Provider Demographics
NPI:1669073789
Name:PELAEZ, MIRNA ANDREA
Entity type:Individual
Prefix:
First Name:MIRNA
Middle Name:ANDREA
Last Name:PELAEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6702 KELLY ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-6526
Mailing Address - Country:US
Mailing Address - Phone:858-213-4124
Mailing Address - Fax:
Practice Address - Street 1:891 KUHN DR STE 110
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3551
Practice Address - Country:US
Practice Address - Phone:619-864-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst