Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 58898 | MN |
Y | 208600000X | Surgeon | 58898 | MN |
N | 208200000X | Surgeon | A129415 | CA |
N | 208600000X | Surgeon | A129415 | CA |
NPI | 1003059379 |
---|---|
Provider Name | Juan Jose Blondet Teixeira |
First Address | Minneapolis, MN 55407-1321 |
Second Address | Saint Paul, MN 55102-2424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2009 |
Last Update Date | 10/11/2020 |