Provider Demographics
NPI:1992488134
Name:LEIVA, ALLISON IVANIA
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:IVANIA
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 1:12149 NAVA ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-6668
Mailing Address - Country:US
Mailing Address - Phone:626-412-5634
Mailing Address - Fax:
Practice Address - Street 1:13135 BARTON RD STE ABC
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-2757
Practice Address - Country:US
Practice Address - Phone:657-242-2079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician