Healthcare Provider Details

I. General information

NPI: 1003732330
Provider Name (Legal Business Name): MATTHEW ALEXANDER LEIVA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 N BUFFALO DR STE 101
LAS VEGAS NV
89128-2679
US

IV. Provider business mailing address

9810 WILD COYOTE CT
LAS VEGAS NV
89141-8746
US

V. Phone/Fax

Practice location:
  • Phone: 702-552-3758
  • Fax:
Mailing address:
  • Phone: 702-552-3758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT6656
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: