Provider Demographics
NPI:1851056642
Name:LEYVA MORALES, SANDRA MARIA
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIA
Last Name:LEYVA MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:MARIA
Other - Last Name:LEYVA MORALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13260 SW 57TH TER APT 9
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-1248
Mailing Address - Country:US
Mailing Address - Phone:783-301-7502
Mailing Address - Fax:786-577-9444
Practice Address - Street 1:13260 SW 57TH TER APT 9
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-1248
Practice Address - Country:US
Practice Address - Phone:783-301-7502
Practice Address - Fax:786-577-9444
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-131325106S00000X
FL100851104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115278100Medicaid