Provider Demographics
NPI:1518449099
Name:LEON LAUSELL, SEBASTIAN SAMUEL (MEDICAL STUDENT)
Entity type:Individual
Prefix:MR
First Name:SEBASTIAN
Middle Name:SAMUEL
Last Name:LEON LAUSELL
Suffix:
Gender:M
Credentials:MEDICAL STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 AVE HOSTOS APT 639
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4244
Mailing Address - Country:US
Mailing Address - Phone:787-423-9223
Mailing Address - Fax:
Practice Address - Street 1:165 AVE HOSTOS APT 639
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4244
Practice Address - Country:US
Practice Address - Phone:787-423-9223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program