Healthcare Provider Details

I. General information

NPI: 1386480606
Provider Name (Legal Business Name): JUAN PELAYO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2024
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 BURNS AVE
LOS ANGELES CA
90029-2702
US

IV. Provider business mailing address

2336 GAIL ST APT 1
LOS ANGELES CA
90031-1057
US

V. Phone/Fax

Practice location:
  • Phone: 323-222-1440
  • Fax:
Mailing address:
  • Phone: 323-636-9361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-NRWXEA
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: