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: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 600 COOK STREET SUITE 100
PALM DESERT CA
92211
US

IV. Provider business mailing address

42 600 COOK STREET SUITE 100
PALM DESERT CA
92211
US

V. Phone/Fax

Practice location:
  • Phone: 760-773-7044
  • Fax:
Mailing address:
  • Phone: 760-773-7044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC20442
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: