Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1147100 | TX |
N | 2251H1200X | Hand | 1147100 | TX |
NPI | 1366452237 |
---|---|
Provider Name | Moses Isaac Blancas |
First Address | El Paso, TX 79913-0520 |
Second Address | El Paso, TX 79936-4564 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 15/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2802654-01 | (05) | TX |