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General NPI Number Information
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NPI Number | 1922168129
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Entity Type | Individual
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Provider Name | ILEANA MARIA LEYVA MD
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Gender | Female
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 01/09/2019
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Provider Practice Location Address
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Address Line | 5420 NW 33RD AVE STE 100
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City | FT LAUDERDALE
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State | FL
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Zip | 33309-6348
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Country | US
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Telephone | 954-486-4085
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Fax |
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Provider Business Mailing Address
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Address Line | 5420 NW 33RD AVE STE 100
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-6348
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Country | US
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Telephone | 954-486-4085
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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 | 2080H0002X
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Taxonomy Name | Pediatric Hospice and Palliative Medicine Physician
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License Number | ME130688
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License Number State | FL
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