Provider Demographics
NPI:1225765019
Name:LEYBA, EDWARD STANLEY (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:STANLEY
Last Name:LEYBA
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 E VALLEY AUTO DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4609
Mailing Address - Country:US
Mailing Address - Phone:480-582-2955
Mailing Address - Fax:480-582-3090
Practice Address - Street 1:3140 N ARIZONA AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-7166
Practice Address - Country:US
Practice Address - Phone:480-409-4787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ278353363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty