Individual
DERRICK KYLE PELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
3883 AIRWAY DR STE 120, SANTA ROSA, CA 95403-1678
(707) 521-4495
(707) 573-5421
Mailing address
325 DISTEL CIR, LOS ALTOS, CA 94022-1408
(707) 521-4495
(707) 573-5421
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
95012148
CA
Other
Enumeration date
08/05/2013
Last updated
02/09/2022
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