Basic Information
| Provider Information | |||||||||
| NPI: | 1194231910 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEYVA | ||||||||
| FirstName: | JAIME | ||||||||
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| Mailing Information | |||||||||
| Address1: | 795 FLETCHER LN | ||||||||
| Address2: | |||||||||
| City: | HAYWARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945441008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102478300 | ||||||||
| FaxNumber: | 5102478295 | ||||||||
| Practice Location | |||||||||
| Address1: | 1310 M ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937211808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592642700 | ||||||||
| FaxNumber: | 5592642700 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2017 | ||||||||
| LastUpdateDate: | 12/18/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.