Provider Demographics
NPI:1184422594
Name:LEYVA, RAFAEL ISAAC (PA)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ISAAC
Last Name:LEYVA
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11104 CAIN HARVEST DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5978
Mailing Address - Country:US
Mailing Address - Phone:737-376-2042
Mailing Address - Fax:
Practice Address - Street 1:11104 CAIN HARVEST DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-5978
Practice Address - Country:US
Practice Address - Phone:737-376-2042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2508363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant