Healthcare Provider Details

I. General information

NPI: 1437353356
Provider Name (Legal Business Name): CARLOS ALBERTO LEYVA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 CALLE DE DIEGO SUITE 209
SAN JUAN PR
00923-3003
US

IV. Provider business mailing address

369 CALLE DE DIEGO SUITE 209
SAN JUAN PR
00923-3003
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-2929
  • Fax: 787-765-4374
Mailing address:
  • Phone: 787-767-2929
  • Fax: 787-765-4374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number18183
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberME104962
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: