Individual
JESSICA MARIAN BLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
44405 WOODWARD AVE, PONTIAC, MI 48341-5023
(248) 858-3000
Mailing address
651 DARWIN ST, WESTLAND, MI 48186-9204
(734) 864-6003
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
363AM0700X
Medical Physician Assistant
Primary
5601010756
MI
Other
Enumeration date
06/15/2018
Last updated
09/14/2021
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