Healthcare Provider Details

I. General information

NPI: 1831442375
Provider Name (Legal Business Name): CARLOS PEAY C.PED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 N TELSHOR BLVD STE H
LAS CRUCES NM
88011-8234
US

IV. Provider business mailing address

532 N TELSHOR BLVD STE H
LAS CRUCES NM
88011-8234
US

V. Phone/Fax

Practice location:
  • Phone: 575-210-1495
  • Fax:
Mailing address:
  • Phone: 575-210-1495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License NumberCPED2904
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: