Provider Demographics
NPI:1942861497
Name:LEITE ABUD, VIVIANE (MD)
Entity Type:Individual
Prefix:
First Name:VIVIANE
Middle Name:
Last Name:LEITE ABUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12631 E 17TH AVE STE C305
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2527
Mailing Address - Country:US
Mailing Address - Phone:303-724-2750
Mailing Address - Fax:303-724-2761
Practice Address - Street 1:12631 E 17TH AVE STE C305
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2527
Practice Address - Country:US
Practice Address - Phone:303-724-2750
Practice Address - Fax:303-724-2761
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019019477208600000X
COTL.0008605390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208600000XAllopathic & Osteopathic PhysiciansSurgery