Healthcare Provider Details

I. General information

NPI: 1871378158
Provider Name (Legal Business Name): ISAAC FERNANDO LEYVA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S FARRELL DR
PALM SPRINGS CA
92262-7905
US

IV. Provider business mailing address

17300 CORKILL RD SPC 105
DESERT HOT SPRINGS CA
92241-9450
US

V. Phone/Fax

Practice location:
  • Phone: 760-894-4070
  • Fax:
Mailing address:
  • Phone: 760-288-6219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC20442
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: