Provider Demographics
NPI:1659926277
Name:LEYVA, LESLY SARAHI I
Entity Type:Individual
Prefix:
First Name:LESLY
Middle Name:SARAHI
Last Name:LEYVA
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LESLY
Other - Middle Name:SARAHI
Other - Last Name:LEYVA
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3303 S ARCHIBALD AVE APT 169
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7967
Mailing Address - Country:US
Mailing Address - Phone:626-625-6328
Mailing Address - Fax:
Practice Address - Street 1:3303 S ARCHIBALD AVE APT 169
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-7967
Practice Address - Country:US
Practice Address - Phone:626-625-6328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA27-3432207Medicaid
CA273432207Medicaid