Provider Demographics
NPI:1720599608
Name:LEYTO, ELIGIE DE VERA (RN)
Entity Type:Individual
Prefix:
First Name:ELIGIE
Middle Name:DE VERA
Last Name:LEYTO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 BISSO LN STE D1
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-4832
Mailing Address - Country:US
Mailing Address - Phone:925-908-6712
Mailing Address - Fax:925-908-6702
Practice Address - Street 1:2400 BISSO LN
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4832
Practice Address - Country:US
Practice Address - Phone:925-908-6712
Practice Address - Fax:925-908-6702
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA765156163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse