Provider Demographics
NPI:1417541699
Name:BLANCO ALONSO, VICTOR MANUEL (CPT)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:MANUEL
Last Name:BLANCO ALONSO
Suffix:
Gender:M
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10660 SW WILSONVILLE RD UNIT 60
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-8598
Mailing Address - Country:US
Mailing Address - Phone:503-550-6384
Mailing Address - Fax:
Practice Address - Street 1:10660 SW WILSONVILLE RD UNIT 60
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-8598
Practice Address - Country:US
Practice Address - Phone:503-550-6384
Practice Address - Fax:503-855-3895
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-27
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3574-160-911-4567246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy