Individual
JOSE BALBOA BLANCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SURGICAL ASSISTANT
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
15-483
CO
363AS0400X
Surgical Physician Assistant
Primary
238.000547
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B411427823290
DRIVER LICENCE
FL
Enumeration date
05/06/2016
Last updated
06/07/2025
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