Provider Demographics
NPI:1346316825
Name:BLANCAFLOR, MARIA ANTONIA BANAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ANTONIA BANAL
Last Name:BLANCAFLOR
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 1:396 CHALAN SAN ANTONIO STE 103
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3301
Mailing Address - Country:US
Mailing Address - Phone:671-648-5437
Mailing Address - Fax:671-649-5437
Practice Address - Street 1:396 CHALAN SAN ANTONIO STE 103
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3301
Practice Address - Country:US
Practice Address - Phone:671-648-5437
Practice Address - Fax:671-649-5437
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM001283174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist