Provider Demographics
NPI:1457176398
Name:LEYVA LEYVA, ANAIDE
Entity type:Individual
Prefix:
First Name:ANAIDE
Middle Name:
Last Name:LEYVA LEYVA
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 1:8665 SW 159TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5299
Mailing Address - Country:US
Mailing Address - Phone:786-246-3785
Mailing Address - Fax:
Practice Address - Street 1:8665 SW 159TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5299
Practice Address - Country:US
Practice Address - Phone:786-246-3785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician