Provider Demographics
NPI:1497432702
Name:BLANCO, GISSELLE FRANCISCA
Entity Type:Individual
Prefix:
First Name:GISSELLE
Middle Name:FRANCISCA
Last Name:BLANCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15459 SW 80TH ST APT 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2688
Mailing Address - Country:US
Mailing Address - Phone:786-230-9471
Mailing Address - Fax:
Practice Address - Street 1:15459 SW 80TH ST APT 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-2688
Practice Address - Country:US
Practice Address - Phone:786-230-9471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician