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General NPI Number Information
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NPI Number | 1619434297
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Entity Type | Individual
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Provider Name | JUAN CARLOS LEYVA MASTER SOCIAL WORKER
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Gender | Male
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Dates
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Enumeration Date | 03/01/2019
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 276 W COLLEGE ST
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City | COVINA
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State | CA
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Zip | 91723-1902
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Country | US
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Telephone | 626-919-4333
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Fax |
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Provider Business Mailing Address
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Address Line | 10418 VALLEY BLVD
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City | EL MONTE
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State | CA
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Zip | 91731-3600
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Country | US
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Telephone |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 112808
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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