Provider Demographics
NPI:1366057499
Name:PELAEZ, JESSICA RACHEL (ASW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RACHEL
Last Name:PELAEZ
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 GARDENIA AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-5182
Mailing Address - Country:US
Mailing Address - Phone:562-355-9624
Mailing Address - Fax:
Practice Address - Street 1:9862 CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-2726
Practice Address - Country:US
Practice Address - Phone:714-620-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95296Medicaid