Provider Demographics
NPI:1003786633
Name:MCINTOSCH LEIVA, HERLYN
Entity type:Individual
Prefix:
First Name:HERLYN
Middle Name:
Last Name:MCINTOSCH LEIVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23945 PICO AVE
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92585-9549
Mailing Address - Country:US
Mailing Address - Phone:951-220-5905
Mailing Address - Fax:
Practice Address - Street 1:23119 SOBOBA RD
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-2904
Practice Address - Country:US
Practice Address - Phone:951-654-0803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-08
Last Update Date:2025-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36096152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist