1922168129 NPI number — DR. ILEANA MARIA LEYVA MD

Table of content: DR. ILEANA MARIA LEYVA MD (NPI 1922168129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922168129 NPI number — DR. ILEANA MARIA LEYVA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEYVA
Provider First Name:
ILEANA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922168129
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5420 NW 33RD AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33309-6348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-486-4085
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5420 NW 33RD AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33309-6348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-486-4085
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080H0002X , with the licence number:  ME130688 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 036089722 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 363149833 . This is a "CDPG TAX IDENTIFICAITON NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: CA4748 . This is a "RAILROAD MEDICARE GROUP PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: L93363 . This is a "PIN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 36-4450982 . This is a "COMFORTLINK TAX ID #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0222075 . This is a "BLUE CROSS GROUP NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 02232008 . This is a "COMFORTLINK BLUE SHIELD G" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1033149844 . This is a "GROUP NPI NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 3631498336019001 . This is a "HFS GROUP PAYEE ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1922168129 . This is a "NPI NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00749841 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 116650400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".