Provider Demographics
NPI:1174886055
Name:LEIVA, ROSA A
Entity type:Individual
Prefix:MISS
First Name:ROSA
Middle Name:A
Last Name: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 1:240 W 98TH ST APT 13G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5534
Mailing Address - Country:US
Mailing Address - Phone:212-866-3049
Mailing Address - Fax:212-866-3049
Practice Address - Street 1:240 W 98TH ST APT 13G
Practice Address - Street 2:APT.13G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5534
Practice Address - Country:US
Practice Address - Phone:212-866-3049
Practice Address - Fax:212-866-3049
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-17
Last Update Date:2012-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY741552174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist