Provider Demographics
NPI:1821977331
Name:URIBE-BALDIVIA, LEONARDO JR
Entity type:Individual
Prefix:
First Name:LEONARDO
Middle Name:
Last Name:URIBE-BALDIVIA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 E BRADLEY ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-3223
Mailing Address - Country:US
Mailing Address - Phone:307-399-7982
Mailing Address - Fax:
Practice Address - Street 1:619 E BRADLEY ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-3223
Practice Address - Country:US
Practice Address - Phone:307-399-7982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health