Provider Demographics
NPI:1366719551
Name:LEIVA, ESTHELA JUDITH
Entity type:Individual
Prefix:DR
First Name:ESTHELA
Middle Name:JUDITH
Last Name:LEIVA
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 1:11107 W 113TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2743
Mailing Address - Country:US
Mailing Address - Phone:913-485-0123
Mailing Address - Fax:913-451-3102
Practice Address - Street 1:11107 W 113TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2743
Practice Address - Country:US
Practice Address - Phone:913-485-0123
Practice Address - Fax:913-451-3102
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist