MEDICARE: STACEY LEIJA

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	315175	AZ

General Provider Information

NPI Number	:	1043031651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY LEIJA

Provider Business Mailing Address
First Line	:	137 E ELLIOT RD UNIT 1605
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85299-6777
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	137 E ELLIOT RD UNIT 1605
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85299-6777
Country	:	US
Telephone Number	:	480-999-5817
Fax Number	:

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

Provider Enumeration Date	:	10/17/2024
Last Update Date	:	08/11/2025

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Directions to “ STACEY LEIJA ” Practice Location

Language	Start Address	Practice Location

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