Provider Demographics
NPI:1992546022
Name:LEYVA BARREDA, KEVIN RENAN
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:RENAN
Last Name:LEYVA BARREDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 HUMMINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-7830
Mailing Address - Country:US
Mailing Address - Phone:786-644-8693
Mailing Address - Fax:
Practice Address - Street 1:6900 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5745
Practice Address - Country:US
Practice Address - Phone:407-602-7442
Practice Address - Fax:786-631-4483
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician