Provider Demographics
NPI:1972647634
Name:GISELA GARCIA- LEYVA MD PA
Entity Type:Organization
Organization Name:GISELA GARCIA- LEYVA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GISELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA LEYVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-823-5555
Mailing Address - Street 1:211 4TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-2911
Mailing Address - Country:US
Mailing Address - Phone:727-823-8366
Mailing Address - Fax:
Practice Address - Street 1:211 4TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-2911
Practice Address - Country:US
Practice Address - Phone:727-823-8366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00364102084P0800X
208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40649Medicare ID - Type Unspecified
FLD53935Medicare UPIN