Provider Demographics
NPI:1376190553
Name:BLANFORT, WILNER
Entity Type:Individual
Prefix:
First Name:WILNER
Middle Name:
Last Name:BLANFORT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 NW 95TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-2615
Mailing Address - Country:US
Mailing Address - Phone:786-804-2746
Mailing Address - Fax:
Practice Address - Street 1:1355 NW 95TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-2615
Practice Address - Country:US
Practice Address - Phone:786-804-2746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver