Basic Information
| Provider Information | |||||||||
| NPI: | 1952361461 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEYBLE | ||||||||
| FirstName: | EUGENE | ||||||||
| MiddleName: | ROLLUQUI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 DATA DR | ||||||||
| Address2: | |||||||||
| City: | RANCHO CORDOVA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956707956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168611486 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1700 PRAIRIE CITY RD | ||||||||
| Address2: | |||||||||
| City: | FOLSOM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956309594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163514800 | ||||||||
| FaxNumber: | 9163514899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 03/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A93856 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD20060037 | NM | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | A93856 | CA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | A93856 | 01 | CA | MEDICAL STATE LICENSE | OTHER | P00331570 | 01 | NM | RAILROAD MEDICARE | OTHER | BL9652353 | 01 | CA | DEA CERTIFICATE | OTHER | 097766 | 01 | NM | CARLSBAD AHCCCS | OTHER | 21053731 | 05 | NM | MEDICAID |