Provider Demographics
NPI:1770355463
Name:LEYVA, EULIS (BS)
Entity type:Individual
Prefix:
First Name:EULIS
Middle Name:
Last Name:LEYVA
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 SW 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2416
Mailing Address - Country:US
Mailing Address - Phone:470-428-0161
Mailing Address - Fax:
Practice Address - Street 1:600 NW 35TH AVE STE 202-203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4000
Practice Address - Country:US
Practice Address - Phone:305-987-2539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty