Provider Demographics
NPI:1437165412
Name:GONZALEZ BLANCO, MERCEDES (MD)
Entity Type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:
Last Name:GONZALEZ BLANCO
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 1:8356 SW 40TH ST STE H
Mailing Address - Street 2:BOX 016960 M851
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3356
Mailing Address - Country:US
Mailing Address - Phone:305-223-9044
Mailing Address - Fax:305-223-9045
Practice Address - Street 1:8356 SW 40 TH ST SUITE H
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155
Practice Address - Country:US
Practice Address - Phone:305-223-9044
Practice Address - Fax:305-223-9045
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME274252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD78884Medicare UPIN
FL95123Medicare ID - Type Unspecified