Provider Demographics
NPI:1093572919
Name:BLANDO, LUZ
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:
Last Name:BLANDO
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 1:1648 EVANS DR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2583
Mailing Address - Country:US
Mailing Address - Phone:904-504-7887
Mailing Address - Fax:
Practice Address - Street 1:10450 SAN JOSE BLVD STE J
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-6257
Practice Address - Country:US
Practice Address - Phone:904-504-7887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty