Provider Demographics
NPI:1265246649
Name:LUVA, LEILANI MONIQUE
Entity type:Individual
Prefix:
First Name:LEILANI
Middle Name:MONIQUE
Last Name:LUVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 S PINE ST APT 209
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-6450
Mailing Address - Country:US
Mailing Address - Phone:909-883-9669
Mailing Address - Fax:
Practice Address - Street 1:2410 STRYKER AVE
Practice Address - Street 2:
Practice Address - City:JOINT BASE LEWIS MCCHORD
Practice Address - State:WA
Practice Address - Zip Code:98433-1031
Practice Address - Country:US
Practice Address - Phone:253-583-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA235Z00000X
WASI61607737235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist