Provider Demographics
NPI:1295325165
Name:LEYVA, CYNTHIA (CPH)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:
Last Name:LEYVA
Suffix:
Gender:F
Credentials:CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93109-1645
Mailing Address - Country:US
Mailing Address - Phone:805-962-8709
Mailing Address - Fax:805-962-7130
Practice Address - Street 1:1835 CLIFF DR
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93109-1645
Practice Address - Country:US
Practice Address - Phone:805-962-8709
Practice Address - Fax:805-962-7130
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530107010130040183700000X
CA64069183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1346283108Medicaid