Healthcare Provider Details

I. General information

NPI: 1841155298
Provider Name (Legal Business Name): BRENDA RIVAS PELAYO AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20414 N 27TH AVE STE 300
PHOENIX AZ
85027-3254
US

IV. Provider business mailing address

20414 N 27TH AVE STE 300
PHOENIX AZ
85027-3254
US

V. Phone/Fax

Practice location:
  • Phone: 623-879-6000
  • Fax: 623-516-2000
Mailing address:
  • Phone: 623-879-6000
  • Fax: 623-516-2000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number235079
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: