Healthcare Provider Details

I. General information

NPI: 1194231910
Provider Name (Legal Business Name): JAIME LEYVA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 M ST
FRESNO CA
93721-1808
US

IV. Provider business mailing address

795 FLETCHER LN
HAYWARD CA
94544-1008
US

V. Phone/Fax

Practice location:
  • Phone: 559-264-2700
  • Fax: 559-264-2700
Mailing address:
  • Phone: 510-247-8300
  • Fax: 510-247-8295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: