Provider Demographics
NPI:1073895611
Name:LEYVA, JUAN PEDRO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:PEDRO
Last Name:LEYVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 N CASA BLANCA DR
Mailing Address - Street 2:# 27
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-6984
Mailing Address - Country:US
Mailing Address - Phone:602-799-2939
Mailing Address - Fax:
Practice Address - Street 1:5101 N CASA BLANCA DR
Practice Address - Street 2:# 27
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-6984
Practice Address - Country:US
Practice Address - Phone:602-799-2939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine