Provider Demographics
NPI:1619017761
Name:BLASCO, HILDEBERT A (MD)
Entity Type:Individual
Prefix:
First Name:HILDEBERT
Middle Name:A
Last Name:BLASCO
Suffix:
Gender:M
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:LB 18 VIA MALLORCA LA ANTIGUA
Mailing Address - Street 2:ENCANTADA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6101
Mailing Address - Country:US
Mailing Address - Phone:787-769-5842
Mailing Address - Fax:
Practice Address - Street 1:401 BLOQUE 139 # 10
Practice Address - Street 2:VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-769-5842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14656207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I19109Medicare UPIN
0022721Medicare ID - Type Unspecified