Basic Information
| Provider Information | |||||||||
| NPI: | 1144362377 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEIVA | ||||||||
| FirstName: | VALERIA | ||||||||
| MiddleName: | IVANNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2740 LYFORD DR | ||||||||
| Address2: | |||||||||
| City: | LA VERNE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917504754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096257207 | ||||||||
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| Practice Location | |||||||||
| Address1: | 790 E BONITA AVE | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917671906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096257207 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.