MEDICARE: EUGENE ROLLUQUI LEYBLE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A93856	CA
2	207R00000X	Internal Medicine Physician	MD20060037	NM
3	208M00000X	Hospitalist Physician	A93856	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00331570	OTHER	NM	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A93856	OTHER	CA	MEDICAL STATE LICENSE
3	097766	OTHER	NM	CARLSBAD AHCCCS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952361461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE ROLLUQUI LEYBLE MD

Provider Business Mailing Address
First Line	:	3400 DATA DR
Second Line	:
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-7956
Country	:	US
Telephone Number	:	916-861-1486
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 PRAIRIE CITY RD
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-9594
Country	:	US
Telephone Number	:	916-351-4800
Fax Number	:	916-351-4899

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	03/07/2023

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