Provider Demographics
NPI:1831442375
Name:PEAY, CARLOS (CPED)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:PEAY
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 N TELSHOR BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8234
Mailing Address - Country:US
Mailing Address - Phone:575-210-1495
Mailing Address - Fax:
Practice Address - Street 1:532 N TELSHOR BLVD STE H
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8234
Practice Address - Country:US
Practice Address - Phone:575-210-1495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPED2904224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist