Provider Demographics
NPI:1912266909
Name:PELC, PIOTR (DO)
Entity Type:Individual
Prefix:DR
First Name:PIOTR
Middle Name:
Last Name:PELC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CORPORATE PLAZA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7939
Mailing Address - Country:US
Mailing Address - Phone:949-312-5752
Mailing Address - Fax:
Practice Address - Street 1:15 CORPORATE PLAZA DR STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7939
Practice Address - Country:US
Practice Address - Phone:949-312-5752
Practice Address - Fax:949-202-1131
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A129912084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry