MEDICARE: RUBEN LEYVA

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1821399080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBEN LEYVA

Provider Business Mailing Address
First Line	:	1427 EL SEGUNDO AVE. N.E.
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1427 EL SEGUNDO AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-1087
Country	:	US
Telephone Number	:	505-212-7350
Fax Number	:

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

Provider Enumeration Date	:	11/04/2010
Last Update Date	:	11/04/2010

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Directions to “ RUBEN LEYVA ” Practice Location

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