Basic Information
| Provider Information | |||||||||
| NPI: | 1265893085 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PELOZA SURGICAL SERVICES, PLLC | ||||||||
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| OtherOrganizationName: | CENTER FOR SPINE CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17980 DALLAS PKWY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752876702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143787200 | ||||||||
| FaxNumber: | 2143787200 | ||||||||
| Practice Location | |||||||||
| Address1: | 17980 DALLAS PKWY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752876702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143787200 | ||||||||
| FaxNumber: | 2143787200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2016 | ||||||||
| LastUpdateDate: | 03/18/2016 | ||||||||
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| AuthorizedOfficialLastName: | PELOZA | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2143787200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA01810 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207XS0117X | G7094 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
No ID Information.