Healthcare Provider Details

I. General information

NPI: 1568102945
Provider Name (Legal Business Name): CRYSTINA LEYVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10603 DOWNEY AVE
DOWNEY CA
90241-3426
US

IV. Provider business mailing address

9647 POMERING RD
DOWNEY CA
90240-3126
US

V. Phone/Fax

Practice location:
  • Phone: 562-622-2268
  • Fax:
Mailing address:
  • Phone: 562-382-5894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: