Basic Information
| Provider Information | |||||||||
| NPI: | 1558935601 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEYBA | ||||||||
| FirstName: | KATARINA | ||||||||
| MiddleName: | RAQUEL | ||||||||
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| Credential: | MBA, MD | ||||||||
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| OtherLastName: | LEYBA | ||||||||
| OtherFirstName: | KATARINA | ||||||||
| OtherMiddleName: | RAQUEL | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | UNIVERSITY OF COLORADO INTERNAL MEDICINE RESIDENCY | ||||||||
| Address2: | 12631 EAST 17TH PLACE, MAILSTOP B177 | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037241784 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12605 E 16TH AVE | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800452545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052359371 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2021 | ||||||||
| LastUpdateDate: | 05/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | TL.0008795 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | TL.0008795 | CO | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.