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General NPI Number Information
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NPI Number | 1326845140
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Entity Type | Individual
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Provider Name | LUCAS NICOLAS LEIVA DC
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Gender | Male
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Dates
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Enumeration Date | 02/27/2025
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 3602 INLAND EMPIRE BLVD
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City | ONTARIO
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State | CA
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Zip | 91764-4900
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Country | US
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Telephone | 909-265-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 306 E CHESTNUT AVE APT A
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City | SANTA ANA
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State | CA
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Zip | 92701-5914
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Country | US
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Telephone | 916-207-8041
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 37190
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License Number State | CA
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