Doctor Name: | MR. LUIS A BLANCO |
NPI Number: | 1043532179 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PAC |
License Number: | 005075-1 |
Business Practice Address: | 6506 Roosevelt Ave Woodside, NY - 113772928 |
Business Phone Number: | 7186062682 |
Business Fax Number: | 7186062962 |
Mailing Address: | 40 Prospect St, MONROE |
State: | NY |
Postal Code: | 109503678 |
Phone Number: | 8452382168 |
Fax Number: | 7186062962 |
NPI Enumeration Date: | 02/16/2010 |
NPI Last Update Date: | 07/08/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 005075-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |