Provider Demographics
NPI:1710615893
Name:OBEN-PEREZ, BLANCA (SLP)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:
Last Name:OBEN-PEREZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 E FLETCHER AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4795
Mailing Address - Country:US
Mailing Address - Phone:813-252-6334
Mailing Address - Fax:813-252-9129
Practice Address - Street 1:3500 E FLETCHER AVE STE 208
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4795
Practice Address - Country:US
Practice Address - Phone:813-252-6334
Practice Address - Fax:813-252-9129
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ10786235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist