Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 110906 | TX |
NPI | 1366925190 |
---|---|
Provider Name | Alejandro Leyva |
First Address | El Paso, TX 79928-5688 |
Second Address | Socorro, TX 79927-4288 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2018 |
Last Update Date | 07/09/2018 |