Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN467468 | CA |
NPI | 1053410753 |
---|---|
Provider Name | Bessie Rosana Blanco |
First Address | Fontana, CA 92336-3329 |
Second Address | Fontana, CA 92336 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 08/08/2018 |