Provider Demographics
NPI:1346258787
Name:FRESNO, BLANCA I (MD)
Entity Type:Individual
Prefix:MS
First Name:BLANCA
Middle Name:I
Last Name:FRESNO
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 1:655 EUCLID AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2968
Mailing Address - Country:US
Mailing Address - Phone:619-475-4575
Mailing Address - Fax:619-475-4578
Practice Address - Street 1:655 EUCLID AVE STE 207
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2968
Practice Address - Country:US
Practice Address - Phone:619-472-4575
Practice Address - Fax:619-475-4578
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG20684Medicare UPIN