Provider Demographics
NPI:1225255250
Name:BLADUELL, NITZA ENID (MD)
Entity Type:Individual
Prefix:DR
First Name:NITZA
Middle Name:ENID
Last Name:BLADUELL
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:AX4 CALLE HERMOSILLO
Mailing Address - Street 2:VENUS GARDENS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4696
Mailing Address - Country:US
Mailing Address - Phone:787-761-1233
Mailing Address - Fax:787-761-1233
Practice Address - Street 1:AX4 CALLE HERMOSILLO
Practice Address - Street 2:VENUS GARDENS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4696
Practice Address - Country:US
Practice Address - Phone:787-761-1233
Practice Address - Fax:787-761-1233
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6331208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics