Healthcare Provider Details

I. General information

NPI: 1053006197
Provider Name (Legal Business Name): CHRISTIAN LEYVA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10425 PAINTER AVE
SANTA FE SPRINGS CA
90670-3429
US

IV. Provider business mailing address

12070 TELEGRAPH RD
SANTA FE SPRINGS CA
90670-3771
US

V. Phone/Fax

Practice location:
  • Phone: 562-906-2685
  • Fax:
Mailing address:
  • Phone: 562-777-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberF2W6F2Y7
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1596270125
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE120558
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: