Individual
MARIO BLANCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2100 PREVATT ST, EUSTIS, FL 32726-6130
(352) 308-8903
(352) 460-0785
Mailing address
2815 GREENBRIAR BLVD, WELLINGTON, FL 33414-7157
(561) 204-5455
(561) 204-5455
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
90265
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1265798870
GROUP NPI
FL
05
—
269882000
—
FL
Enumeration date
03/18/2006
Last updated
10/03/2019
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