Provider Demographics
NPI:1992703714
Name:LEYVA, JOSE J (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:J
Last Name:LEYVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:J
Other - Last Name:LEYVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 27903
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77227-7903
Mailing Address - Country:US
Mailing Address - Phone:832-407-2541
Mailing Address - Fax:713-439-0163
Practice Address - Street 1:11275 S SAM HOUSTON PKWY W
Practice Address - Street 2:SUITE 150
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77031-2357
Practice Address - Country:US
Practice Address - Phone:832-328-4545
Practice Address - Fax:832-328-4548
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD37402084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0967168-01Medicaid
TX0967168-01Medicaid