Provider Information for 1285131177
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CAROLINA A LEIVA
Sex: Female
NPI: 1285131177
Last Updated: 2024-06-10
Certification Date: 2024-06-10
Certification Date: 2024-06-10
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1285131177 | ||||||||
| Enumeration Date | 2018-04-09 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 646 BURDETT, NY 14818-0646 United States Phone: 607-288-2332 | Fax: | ||||||||
| Primary Practice Address | 6245 CAYUTAVILLE RD ALPINE, NY 14805-9752 United States Phone: 607-288-2332 | Fax: | ||||||||
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