Provider Demographics
NPI:1730125105
Name:LEYBA JR, MAURO KWEK (MD)
Entity Type:Individual
Prefix:
First Name:MAURO
Middle Name:KWEK
Last Name:LEYBA JR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7085 N CHESTNUT AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0353
Mailing Address - Country:US
Mailing Address - Phone:559-299-2600
Mailing Address - Fax:559-299-2854
Practice Address - Street 1:7085 N CHESTNUT AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0353
Practice Address - Country:US
Practice Address - Phone:559-299-2600
Practice Address - Fax:559-299-2854
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2009-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41228207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A412280Medicaid
CA00A412280Medicare ID - Type Unspecified
CA00A412280Medicaid