Provider Demographics
NPI:1366642332
Name:BLAS-BORIA, DAVID E (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:BLAS-BORIA
Suffix:
Gender:M
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:RR 36 BOX 1362
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9704
Mailing Address - Country:US
Mailing Address - Phone:787-479-6889
Mailing Address - Fax:
Practice Address - Street 1:30 CALLE PADIAL GATSBY PLAZA
Practice Address - Street 2:SUITE 318
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3807
Practice Address - Country:US
Practice Address - Phone:787-479-6889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR172162084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology