Provider Demographics
NPI:1083727788
Name:PLAZA, BLANCA I (MD)
Entity Type:Individual
Prefix:MR
First Name:BLANCA
Middle Name:I
Last Name:PLAZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 CARR 693 PMB 276
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4802
Mailing Address - Country:US
Mailing Address - Phone:787-796-6464
Mailing Address - Fax:787-796-2030
Practice Address - Street 1:CARR. 695 KM. 0.4
Practice Address - Street 2:BO. HIGUILLAR
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-796-6464
Practice Address - Fax:787-796-2030
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH98823Medicare UPIN
PR0022171Medicare ID - Type Unspecified