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General NPI Number Information
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NPI Number | 1164242277
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Entity Type | Individual
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Provider Name | LEIVYS CRUZ MARSALL PA
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Gender | Male
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Dates
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Enumeration Date | 10/14/2024
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 1004 W LINEBAUGH AVE STE A
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City | TAMPA
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State | FL
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Zip | 33612-7837
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Country | US
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Telephone | 813-443-5370
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Fax |
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Provider Business Mailing Address
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Address Line | 10789 IRONWOOD TREE WAY
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City | SAN ANTONIO
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State | FL
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Zip | 33576-7370
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Country | US
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Telephone | 954-774-7690
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | TPPA800
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2180PA
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PACN66
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License Number State | FL
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