Provider Demographics
NPI:1649037094
Name:LEONTYEVA, MARIYA A (FNP-C)
Entity type:Individual
Prefix:
First Name:MARIYA
Middle Name:A
Last Name:LEONTYEVA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 N SAN MATEO DR # 2
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2824
Mailing Address - Country:US
Mailing Address - Phone:650-513-6651
Mailing Address - Fax:
Practice Address - Street 1:34 N SAN MATEO DR # 2
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2824
Practice Address - Country:US
Practice Address - Phone:650-513-6651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028520363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily