Provider Demographics
NPI:1386452589
Name:LEYVA DE MARTINEZ, TRINIDAD
Entity type:Individual
Prefix:MRS
First Name:TRINIDAD
Middle Name:
Last Name:LEYVA DE MARTINEZ
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 1:2625 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-4135
Mailing Address - Country:US
Mailing Address - Phone:531-299-1580
Mailing Address - Fax:
Practice Address - Street 1:2625 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-4135
Practice Address - Country:US
Practice Address - Phone:531-299-1580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant