Provider Demographics
NPI:1659763159
Name:BLANCO & BLANCO PSYCHOLOGY AND BEST LIFE CLINIC
Entity Type:Organization
Organization Name:BLANCO & BLANCO PSYCHOLOGY AND BEST LIFE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLO
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-906-9696
Mailing Address - Street 1:B5 CALLE TABONUCO STE 203
Mailing Address - Street 2:GALERIA SAN PATRICIO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-3004
Mailing Address - Country:US
Mailing Address - Phone:787-906-9696
Mailing Address - Fax:
Practice Address - Street 1:B5 CALLE TABONUCO STE 203
Practice Address - Street 2:GALERIA SAN PATRICIO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-3004
Practice Address - Country:US
Practice Address - Phone:787-906-9696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-21
Last Update Date:2015-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004727261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)