Provider Demographics
NPI:1518165653
Name:LEIVA, MARIBEL (CATC)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:LEIVA
Suffix:
Gender:F
Credentials:CATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SNEATH LN STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2349
Mailing Address - Country:US
Mailing Address - Phone:415-558-9125
Mailing Address - Fax:650-244-1447
Practice Address - Street 1:1724 BRYANT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110
Practice Address - Country:US
Practice Address - Phone:415-558-9125
Practice Address - Fax:415-558-9160
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA144641 -CAADE101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38932OtherAVIVA- MOM
CA38935OtherAVIVA- BABIES