Provider Demographics
NPI:1255331872
Name:BLASINI, AIDA L (MD)
Entity Type:Individual
Prefix:DR
First Name:AIDA
Middle Name:L
Last Name:BLASINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AIDA
Other - Middle Name:L
Other - Last Name:BLASINI-TORRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1503 CALLE PROF AUGUSTO RODRIGUEZ
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2275
Mailing Address - Country:US
Mailing Address - Phone:787-726-5037
Mailing Address - Fax:787-726-5043
Practice Address - Street 1:1503 CALLE PROF AUGUSTO RODRIGUEZ
Practice Address - Street 2:1ST FLOOR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2275
Practice Address - Country:US
Practice Address - Phone:787-726-5037
Practice Address - Fax:787-726-5043
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017534207R00000X
PR007516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR23961OtherTRIPLE-S
4011571OtherAETNA
PR50291OtherOPTION HEALTH
LA1357391Medicaid
PR11591OtherPROSALUD
LA115946OtherUNITED HEALTHCARE
PR4995OtherPMC
PR500652EOtherMMM
LA115946OtherUNITED HEALTHCARE
4011571OtherAETNA