| Doctor Name: | MR. GUSTAVO DARIO BLANCAS |
| NPI Number: | 1184054959 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ARNP |
| License Number: | ARNP9268820 |
| Business Practice Address: | 1541 S Wickham Rd West Melbourne, FL - 329043540 |
| Business Phone Number: | 3217266331 |
| Business Fax Number: | 3217336221 |
| Mailing Address: | 3466 N Harbor City Blvd, MELBOURNE |
| State: | FL |
| Postal Code: | 329355713 |
| Phone Number: | 3214341981 |
| Fax Number: | 3219517408 |
| NPI Enumeration Date: | 11/15/2013 |
| NPI Last Update Date: | 01/15/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | ARNP9268820 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |