Healthcare Provider Details

I. General information

NPI: 1790619146
Provider Name (Legal Business Name): ALEXIS THALIA LEYVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7650 E BROADWAY BLVD STE 105
TUCSON AZ
85710-3772
US

IV. Provider business mailing address

951 W COVENTRY PL
TUCSON AZ
85756-7206
US

V. Phone/Fax

Practice location:
  • Phone: 520-703-6483
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA17405
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: