Provider Demographics
NPI:1720603509
Name:LEYVA, VANESSA IVANNA
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:IVANNA
Last Name:LEYVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95824-2418
Mailing Address - Country:US
Mailing Address - Phone:916-210-8773
Mailing Address - Fax:916-395-5904
Practice Address - Street 1:3301 37TH AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95824-2418
Practice Address - Country:US
Practice Address - Phone:916-210-8773
Practice Address - Fax:916-395-5904
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator