Provider Demographics
NPI:1245930791
Name:GARCIA LEIVA NURSING PRACTITIONER HEALTH CORPORATION
Entity type:Organization
Organization Name:GARCIA LEIVA NURSING PRACTITIONER HEALTH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARILE
Authorized Official - Middle Name:GARCIA
Authorized Official - Last Name:LEIVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-393-1945
Mailing Address - Street 1:801 S CHEVY CHASE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4437
Mailing Address - Country:US
Mailing Address - Phone:818-246-2456
Mailing Address - Fax:
Practice Address - Street 1:801 S CHEVY CHASE DR STE 100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4437
Practice Address - Country:US
Practice Address - Phone:818-246-2456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care