| Doctor Name: | MR. MARTIN BLANCO |
| NPI Number: | 1063673754 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DACII |
| License Number: | A3765798 |
| Business Practice Address: | 1600 Solano St Corning, CA - 960212952 |
| Business Phone Number: | 5308244890 |
| Business Fax Number: | 5308248443 |
| Mailing Address: | Po Box 400, RED BLUFF |
| State: | CA |
| Postal Code: | 960800400 |
| Phone Number: | 5308244890 |
| Fax Number: | 5308248443 |
| NPI Enumeration Date: | 06/24/2008 |
| NPI Last Update Date: | 06/24/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | A3765798 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |