Healthcare Provider Details

I. General information

NPI: 1083167589
Provider Name (Legal Business Name): MS. MARITZA PELAYO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

954 W FOOTHILL BLVD STE A
UPLAND CA
91786-3782
US

IV. Provider business mailing address

954 W FOOTHILL BLVD STE A
UPLAND CA
91786-3782
US

V. Phone/Fax

Practice location:
  • Phone: 909-946-4222
  • Fax: 909-946-8243
Mailing address:
  • Phone: 909-946-4222
  • Fax: 909-946-8243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: