Provider Demographics
NPI:1083185474
Name:LEYVA, RAY JOANNE (RCFE ADMINISTRATOR)
Entity Type:Individual
Prefix:
First Name:RAY JOANNE
Middle Name:
Last Name:LEYVA
Suffix:
Gender:F
Credentials:RCFE ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15617 RED OAK WAY
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-3228
Mailing Address - Country:US
Mailing Address - Phone:760-241-9075
Mailing Address - Fax:760-241-9075
Practice Address - Street 1:15617 RED OAK WAY
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-3228
Practice Address - Country:US
Practice Address - Phone:760-241-9075
Practice Address - Fax:760-241-9075
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA361800212311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility