Provider Demographics
NPI:1073018396
Name:LEYESA, MARIA ELOIZA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ELOIZA
Last Name:LEYESA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10518 PEACH TREE LN
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-2441
Mailing Address - Country:US
Mailing Address - Phone:909-223-8800
Mailing Address - Fax:
Practice Address - Street 1:10518 PEACH TREE LN
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91737-2441
Practice Address - Country:US
Practice Address - Phone:909-223-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18451225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist