Provider Demographics
NPI:1013585587
Name:BLANCO, NADIA HEIDI (FNP)
Entity Type:Individual
Prefix:MRS
First Name:NADIA
Middle Name:HEIDI
Last Name:BLANCO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NADIA
Other - Middle Name:HEIDI
Other - Last Name:HERANADEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1521 E BACH ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2417
Mailing Address - Country:US
Mailing Address - Phone:424-477-4857
Mailing Address - Fax:
Practice Address - Street 1:11946 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3016
Practice Address - Country:US
Practice Address - Phone:310-675-1136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017286363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty