Healthcare Provider Details

I. General information

NPI: 1578480653
Provider Name (Legal Business Name): OLIVER LEE PELAYO MSN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 SW 110TH AVE STE 5
BEAVERTON OR
97005-3016
US

IV. Provider business mailing address

650 S GAINES ST APT 1702
PORTLAND OR
97239-4771
US

V. Phone/Fax

Practice location:
  • Phone: 971-801-9324
  • Fax:
Mailing address:
  • Phone: 971-801-9324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201392255RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: