Healthcare Provider Details

I. General information

NPI: 1538082128
Provider Name (Legal Business Name): LEYSHLA BETH SANTANA OLIVO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 E MAIN ST
MESA AZ
85203-8947
US

IV. Provider business mailing address

1345 E MAIN ST
MESA AZ
85203-8947
US

V. Phone/Fax

Practice location:
  • Phone: 480-300-4741
  • Fax: 510-947-7258
Mailing address:
  • Phone: 480-300-4741
  • Fax: 510-947-7258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: