Basic Information
| Provider Information | |||||||||
| NPI: | 1942861497 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEITE ABUD | ||||||||
| FirstName: | VIVIANE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12631 E 17TH AVE STE C305 | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800452527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037242750 | ||||||||
| FaxNumber: | 3037242761 | ||||||||
| Practice Location | |||||||||
| Address1: | 12631 E 17TH AVE STE C305 | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800452527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037242750 | ||||||||
| FaxNumber: | 3037242761 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2019 | ||||||||
| LastUpdateDate: | 07/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 2019019477 | MO | N | Allopathic & Osteopathic Physicians | Surgery | 390200000X | TL.0008605 | CO | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.