Provider Demographics
NPI:1932752672
Name:TUBAC, LEA JUAN
Entity type:Individual
Prefix:MRS
First Name:LEA
Middle Name:JUAN
Last Name:TUBAC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8713 N NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2138
Mailing Address - Country:US
Mailing Address - Phone:847-707-1823
Mailing Address - Fax:847-966-6387
Practice Address - Street 1:8713 N NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2138
Practice Address - Country:US
Practice Address - Phone:847-707-1823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide