Provider Demographics
NPI:1609497643
Name:LEYVA, RENAN
Entity type:Individual
Prefix:
First Name:RENAN
Middle Name:
Last Name:LEYVA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 NW 86TH CT UNIT 1305
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-6818
Mailing Address - Country:US
Mailing Address - Phone:786-406-4376
Mailing Address - Fax:
Practice Address - Street 1:375 NW 86TH CT UNIT 1305
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-6818
Practice Address - Country:US
Practice Address - Phone:786-406-4376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-20-41691103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst