Provider Demographics
NPI:1669812640
Name:BLANCO, DAINIER (BA)
Entity Type:Individual
Prefix:
First Name:DAINIER
Middle Name:
Last Name:BLANCO
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11845 SW 26TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-2450
Mailing Address - Country:US
Mailing Address - Phone:786-306-2849
Mailing Address - Fax:
Practice Address - Street 1:11845 SW 26TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-2450
Practice Address - Country:US
Practice Address - Phone:786-306-2849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)