Provider Demographics
NPI:1023380557
Name:BARRIOS DE REYES, BLANCA MATILDE
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:MATILDE
Last Name:BARRIOS DE REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16652 SW WARFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:34956-4407
Mailing Address - Country:US
Mailing Address - Phone:772-597-0578
Mailing Address - Fax:772-597-0579
Practice Address - Street 1:1631 LAKEFIELD NORTH CT
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-1066
Practice Address - Country:US
Practice Address - Phone:561-792-9319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator