Provider Demographics
NPI:1558935601
Name:LEYBA, KATARINA RAQUEL (MBA, MD)
Entity Type:Individual
Prefix:
First Name:KATARINA
Middle Name:RAQUEL
Last Name:LEYBA
Suffix:
Gender:F
Credentials:MBA, MD
Other - Prefix:
Other - First Name:KATARINA
Other - Middle Name:RAQUEL
Other - Last Name:LEYBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF COLORADO INTERNAL MEDICINE RESIDENCY
Mailing Address - Street 2:12631 EAST 17TH PLACE, MAILSTOP B177
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045
Mailing Address - Country:US
Mailing Address - Phone:303-724-1784
Mailing Address - Fax:
Practice Address - Street 1:12605 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2545
Practice Address - Country:US
Practice Address - Phone:505-235-9371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL.0008795207R00000X, 390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine