Provider Demographics
NPI:1871550509
Name:GARCIA-LEYVA, GISELA (MD)
Entity type:Individual
Prefix:
First Name:GISELA
Middle Name:
Last Name:GARCIA-LEYVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 4TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-2911
Mailing Address - Country:US
Mailing Address - Phone:727-823-8366
Mailing Address - Fax:
Practice Address - Street 1:211 4TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-2911
Practice Address - Country:US
Practice Address - Phone:727-823-8366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00364102084P0800X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40649OtherBLUE CROSS BLUE SHIELD
FL065718200Medicaid
FL593034992OtherTRICARE
FL065718200Medicaid
FL40649OtherBLUE CROSS BLUE SHIELD
FLD53935Medicare UPIN