Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | OS7055 | FL |
Y | 2080P0202X | Pediatric Cardiologist | OS7055 | FL |
NPI | 1053309617 |
---|---|
Provider Name | Alice Blavo |
First Address | Coral Gables, FL 33146-2423 |
Second Address | Coral Gables, FL 33146-2423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2005 |
Last Update Date | 25/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
263661700 | (05) | FL |