Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME90706 | FL |
Y | 2080P0205X | Pediatric Endocrinologist | ME90706 | FL |
NPI | 1316902430 |
---|---|
Provider Name | Ernesto Jose Blanco |
First Address | Fort Lauderdale, FL 33309-3750 |
Second Address | Fort Lauderdale, FL 33316-2521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 23/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
270373400 | (05) | FL |
I10358 | (02) |