Provider Demographics
NPI:1760074801
Name:PALMA LEYVA, JAZMIN (RBT)
Entity Type:Individual
Prefix:
First Name:JAZMIN
Middle Name:
Last Name:PALMA LEYVA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4170 N 108TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-5469
Mailing Address - Country:US
Mailing Address - Phone:480-751-1957
Mailing Address - Fax:832-383-8823
Practice Address - Street 1:4170 N 108TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5469
Practice Address - Country:US
Practice Address - Phone:480-751-1957
Practice Address - Fax:832-383-8823
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20-145404106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician