Healthcare Provider Details

I. General information

NPI: 1922168129
Provider Name (Legal Business Name): ILEANA MARIA LEYVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5420 NW 33RD AVE STE 100
FT LAUDERDALE FL
33309-6348
US

IV. Provider business mailing address

5420 NW 33RD AVE STE 100
FORT LAUDERDALE FL
33309-6348
US

V. Phone/Fax

Practice location:
  • Phone: 954-486-4085
  • Fax:
Mailing address:
  • Phone: 954-486-4085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License NumberME130688
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: