Healthcare Provider Details

I. General information

NPI: 1669725016
Provider Name (Legal Business Name): CHRISTOPHER PELAYO LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-408 AKOKI ST STE. 202
WAIPAHU HI
96797-2733
US

IV. Provider business mailing address

47-464 HOOPALA ST
KANEOHE HI
96744-4876
US

V. Phone/Fax

Practice location:
  • Phone: 808-676-5584
  • Fax:
Mailing address:
  • Phone: 808-497-2147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2006
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: