Individual
MR. TOM E BLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MAT, ATC
Contact information
Practice address
515 W COLLEGE AVE, LOMPOC, CA 93436-4401
(805) 742-3000
Mailing address
515 W COLLEGE AVE, LOMPOC, CA 93436-4401
(805) 742-3000
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
05/01/2007
Last updated
07/08/2007
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