Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | ||
N | 175L00000X | Homeopath |
NPI | 1972078202 |
---|---|
Provider Name | Mr. Jovan Christopher Leyva |
First Address | San Marcos, CA 92069-2783 |
Second Address | San Marcos, CA 92078-1112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2018 |
Last Update Date | 26/12/2020 |