Provider Demographics
NPI:1821527912
Name:LEYVA, JUAN MANUEL JR (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:MANUEL
Last Name:LEYVA
Suffix:JR
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 RUBEN TORRES SR BLVD STE C6-7
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-5203
Mailing Address - Country:US
Mailing Address - Phone:956-831-0880
Mailing Address - Fax:956-831-0815
Practice Address - Street 1:810 W OCEAN BLVD STE A1
Practice Address - Street 2:
Practice Address - City:LOS FRESNOS
Practice Address - State:TX
Practice Address - Zip Code:78566
Practice Address - Country:US
Practice Address - Phone:956-233-3778
Practice Address - Fax:956-233-3779
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133980363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily