Provider Demographics
NPI:1518571520
Name:LEYVA, ISABEL (RD)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:LEYVA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5939 MAYCREST AVE
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-8619
Mailing Address - Country:US
Mailing Address - Phone:951-533-8195
Mailing Address - Fax:
Practice Address - Street 1:5939 MAYCREST AVE
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-8619
Practice Address - Country:US
Practice Address - Phone:951-533-8195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-07
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86151405133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered