Provider Demographics
NPI:1639943582
Name:BLANCO, MARIA (BS FSHD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BLANCO
Suffix:
Gender:F
Credentials:BS FSHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 S ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7364
Mailing Address - Country:US
Mailing Address - Phone:928-550-0756
Mailing Address - Fax:
Practice Address - Street 1:2545 S ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7364
Practice Address - Country:US
Practice Address - Phone:928-550-0756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker