Provider Demographics
NPI:1235965286
Name:LEYVA CARTAYA, CAMILO ALBERTO
Entity type:Individual
Prefix:
First Name:CAMILO
Middle Name:ALBERTO
Last Name:LEYVA CARTAYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6250 HAZELTINE NATIONAL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-5102
Mailing Address - Country:US
Mailing Address - Phone:407-912-1972
Mailing Address - Fax:833-792-1182
Practice Address - Street 1:6250 HAZELTINE NATIONAL DR STE 102
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-5102
Practice Address - Country:US
Practice Address - Phone:407-912-1972
Practice Address - Fax:833-792-1182
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT24371458106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician