Organization
LUIS A. BLANCO M.D. PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LUIS A BLANCO M.D. (PRESIDENT)
(305) 554-0044
Entity
Organization
Contact information
Practice address
8752 SW 8TH ST, MIAMI, FL 33174-3201
(305) 554-0044
Mailing address
8752 SW 8TH ST, MIAMI, FL 33174-3201
(305) 554-0044
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
261QM2500X
Medical Specialty Clinic/Center
ME49234
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
296978800
—
FL
01
—
ME49234
MEDICAL LICENSE
FL
Enumeration date
12/11/2014
Last updated
11/15/2022
Update your record
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