Individual
MAELA BLANCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5145 ALMEDA AVE, 2D, FAR ROCKAWAY, NV 11691
(646) 207-9317
Mailing address
5145 ALMEDA AVE, 2D, FAR ROCKAWAY, NY 11691-1016
(646) 207-9317
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
496221111
NY
174400000X
Specialist
Primary
543177111
NY
Other
Enumeration date
09/25/2012
Last updated
09/25/2012
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