Healthcare Provider Details

I. General information

NPI: 1497914642
Provider Name (Legal Business Name): DAVID L SCHUB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CRAVEN RD DEPARTMENT OF ORTHOPAEDICS
SAN MARCOS CA
92078-4201
US

IV. Provider business mailing address

400 CRAVEN RD DEPARTMENT OF ORTHOPAEDICS
SAN MARCOS CA
92078-4201
US

V. Phone/Fax

Practice location:
  • Phone: 619-528-5000
  • Fax:
Mailing address:
  • Phone: 619-528-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA124580
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: