Provider Demographics
NPI:1619411048
Name:LEYVA, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LEYVA
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 1:12208 W PARKWAY LN BLDG 15
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-4210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NMRTU SOUDA BAY
Practice Address - Street 2:PSC 814 BOX 19
Practice Address - City:AE
Practice Address - State:GREECE
Practice Address - Zip Code:09865
Practice Address - Country:GR
Practice Address - Phone:904-629-9392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-04
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman