Healthcare Provider Details

I. General information

NPI: 1255117966
Provider Name (Legal Business Name): HECTOR LEIVA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 E CARSON PLAZA DR STE 206B
CARSON CA
90746-3252
US

IV. Provider business mailing address

460 E CARSON PLAZA DR STE 206B
CARSON CA
90746-3252
US

V. Phone/Fax

Practice location:
  • Phone: 323-336-4138
  • Fax:
Mailing address:
  • Phone: 323-336-4138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-195371
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: