Provider Demographics
NPI:1548419047
Name:SHIRALE, BLANCA
Entity Type:Individual
Prefix:MRS
First Name:BLANCA
Middle Name:
Last Name:SHIRALE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:BLANCA
Other - Middle Name:VERONICA
Other - Last Name:LLAMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 W. 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731
Mailing Address - Country:US
Mailing Address - Phone:310-519-6100
Mailing Address - Fax:
Practice Address - Street 1:150 W. 7TH STREET
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731
Practice Address - Country:US
Practice Address - Phone:310-519-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA598981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical