MEDICARE: CHRISTINE LEYVA BUCCIO MA

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	106H00000X	Marriage & Family Therapist	MFC52501	CA

General Provider Information

NPI Number	:	1902131386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE LEYVA BUCCIO MA

Provider Business Mailing Address
First Line	:	2629 FOOTHILL BLVD # 487
Second Line	:
City	:	LA CRESCENTA
State	:	CA
Zip	:	91214-3511
Country	:	US
Telephone Number	:	818-770-5723
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 N CENTRAL AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-2937
Country	:	US
Telephone Number	:	818-770-5723
Fax Number	:

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

Provider Enumeration Date	:	10/02/2009
Last Update Date	:	08/04/2023

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