| Carlos A. Blanco | |
|
11341 Nw 42nd Ter Doral FL 33178-1810 | |
| (305) 761-9392 | |
| (305) 381-0548 |
| Full Name | Carlos A. Blanco |
|---|---|
| Speciality | Family Medicine |
| Location | 11341 Nw 42nd Ter, Doral, Florida |
| Authorized Official Name and Position | Carlos A Blanco (PRESIDENT) |
| Authorized Official Contact | 3057619392 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carlos A. Blanco Po Box 527432 Miami FL 33152-7432 Ph: (305) 761-9392 | Carlos A. Blanco 11341 Nw 42nd Ter Doral FL 33178-1810 Ph: (305) 761-9392 |
| NPI Number | 1043413727 |
|---|---|
| Provider Enumeration Date | 06/08/2007 |
| Last Update Date | 02/03/2012 |
| Medicare PECOS PAC ID | 6800935610 |
|---|---|
| Medicare Enrollment ID | O20091207000567 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043413727 | NPI | - | NPPES |
| 250957100 | Medicaid | FL | |
| 1699716670 | Other | FL | INDIVIDUAL NPI |
| 266547600 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME 71266 (Florida) | Primary |
| Provider Name | Carlos A Blanco |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1699716670 PECOS PAC ID: 6800881657 Enrollment ID: I20040421000011 |
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