Healthcare Provider Details

I. General information

NPI: 1477473809
Provider Name (Legal Business Name): JAIME MIGUEL LEYVA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 N VAN NESS AVE
FRESNO CA
93728-3419
US

IV. Provider business mailing address

185 ROBERTS AVE APT 105
MADERA CA
93637-3181
US

V. Phone/Fax

Practice location:
  • Phone: 559-266-9581
  • Fax: 559-498-0507
Mailing address:
  • Phone: 661-401-9515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number23015
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: