Healthcare Provider Details

I. General information

NPI: 1043835093
Provider Name (Legal Business Name): KATELYN PELOZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S CHIPETA WAY RM 1000
SALT LAKE CITY UT
84108-1222
US

IV. Provider business mailing address

501 S CHIPETA WAY RM 1000
SALT LAKE CITY UT
84108-1222
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-0895
  • Fax:
Mailing address:
  • Phone: 801-585-0895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number14260162-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number96849
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: