Healthcare Provider Details

I. General information

NPI: 1851582670
Provider Name (Legal Business Name): ENRIQUE PELAYO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8780 SW 8TH ST
MIAMI FL
33174-3201
US

IV. Provider business mailing address

8780 SW 8TH ST
MIAMI FL
33174-3201
US

V. Phone/Fax

Practice location:
  • Phone: 305-554-6198
  • Fax: 305-554-6199
Mailing address:
  • Phone: 305-554-6198
  • Fax: 305-554-6199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ENRIQUE PELAYO JR.
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 305-554-6198