MEDICARE: MATTHEW ALEXANDER LEIVA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT6656	NV

General Provider Information

NPI Number	:	1003732330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW ALEXANDER LEIVA

Provider Business Mailing Address
First Line	:	9810 WILD COYOTE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-8746
Country	:	US
Telephone Number	:	702-552-3758
Fax Number	:

Provider Business Practice Location Address
First Line	:	1770 N BUFFALO DR STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-2679
Country	:	US
Telephone Number	:	702-552-3758
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2026
Last Update Date	:	06/29/2026

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