Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | ME 49234 | FL |
NPI | 1558580522 |
---|---|
Provider Name | Dr. Luis A Blanco |
First Address | Miami, FL 33174-3201 |
Second Address | Miami, FL 33174-3201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
269978800 | (05) | FL |