Provider Demographics
NPI:1972513687
Name:SHUB, LEONEL (MD)
Entity type:Individual
Prefix:
First Name:LEONEL
Middle Name:
Last Name:SHUB
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 1:803 HIPODROMO AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00909
Mailing Address - Country:UM
Mailing Address - Phone:787-724-3734
Mailing Address - Fax:787-724-1322
Practice Address - Street 1:803 AVE HIPODROMO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2516
Practice Address - Country:US
Practice Address - Phone:787-724-3734
Practice Address - Fax:787-724-1322
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR010680146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant