Healthcare Provider Details

I. General information

NPI: 1225746167
Provider Name (Legal Business Name): YASSAM LEYVA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10020 NW 128TH TER
HIALEAH FL
33018-1650
US

IV. Provider business mailing address

10020 NW 128TH TER
HIALEAH FL
33018-1650
US

V. Phone/Fax

Practice location:
  • Phone: 305-319-1663
  • Fax:
Mailing address:
  • Phone: 305-319-1663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2831420
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: