Healthcare Provider Details

I. General information

NPI: 1063325199
Provider Name (Legal Business Name): CYNTHIA PELSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3481 STANCREST DR UNIT 321
GLENDALE CA
91208-1303
US

IV. Provider business mailing address

3481 STANCREST DR UNIT 321
GLENDALE CA
91208-1303
US

V. Phone/Fax

Practice location:
  • Phone: 323-793-8545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number28507
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: