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Individual

DR. ILEANA MARIA LEYVA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
5420 NW 33RD AVE STE 100, FT LAUDERDALE, FL 33309-6348
(954) 486-4085
Mailing address
5420 NW 33RD AVE STE 100, FORT LAUDERDALE, FL 33309-6348
(954) 486-4085

Taxonomy

Speciality
Code
Description
License number
State
2080H0002X
Pediatric Hospice and Palliative Medicine Physician
Primary
ME130688
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0222075
BLUE CROSS GROUP NUMBER
IL
01
02232008
COMFORTLINK BLUE SHIELD G
IL
05
036089722
IL
01
1033149844
GROUP NPI NUMBER
IL
01
1922168129
NPI NUMBER
IL
01
36-4450982
COMFORTLINK TAX ID #
IL
01
363149833
CDPG TAX IDENTIFICAITON NUMBER
IL
01
3631498336019001
HFS GROUP PAYEE ID
IL
01
CA4748
RAILROAD MEDICARE GROUP PTAN
IL
01
L93363
PIN
IL
01
P00749841
RAILROAD MEDICARE PTAN
IL
Enumeration date
12/11/2006
Last updated
01/09/2019
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