Provider Demographics
NPI:1750856027
Name:BLANCO, MARIA EUGENIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:EUGENIA
Last Name:BLANCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W 79TH ST APT D3
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-3578
Mailing Address - Country:US
Mailing Address - Phone:786-367-4122
Mailing Address - Fax:
Practice Address - Street 1:1100 W 79TH ST APT D3
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-3578
Practice Address - Country:US
Practice Address - Phone:786-367-4122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-67665106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician