MEDICARE: AARON DANIEL LEIVA ZULETA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1316649080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON DANIEL LEIVA ZULETA

Provider Business Mailing Address
First Line	:	2043 CEDAR ST
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-3111
Country	:	US
Telephone Number	:	847-414-5002
Fax Number	:

Provider Business Practice Location Address
First Line	:	2043 CEDAR ST
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-3111
Country	:	US
Telephone Number	:	847-414-5002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	03/23/2023

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