Healthcare Provider Details

I. General information

NPI: 1871137950
Provider Name (Legal Business Name): CLARISSA MARLENE LEYVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N ECKHOFF ST
ORANGE CA
92868-1008
US

IV. Provider business mailing address

800 N ECKHOFF ST
ORANGE CA
92868-1008
US

V. Phone/Fax

Practice location:
  • Phone: 714-704-6100
  • Fax: 714-704-8806
Mailing address:
  • Phone: 714-704-6100
  • Fax: 714-704-8806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: