Provider Demographics
NPI:1801853627
Name:BLANCO, EMILIO (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:
Last Name:BLANCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7150 W 20TH AVE
Mailing Address - Street 2:STE 609
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5534
Mailing Address - Country:US
Mailing Address - Phone:305-825-1080
Mailing Address - Fax:
Practice Address - Street 1:7150 W 20TH AVE
Practice Address - Street 2:STE 609
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5534
Practice Address - Country:US
Practice Address - Phone:305-825-1080
Practice Address - Fax:305-825-1087
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37187207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
96183OtherBLUE CROSS BLUE SHIELD
1441HILHOtherNEIGHBORHOOD HEALTH
FL068357400Medicaid
96183OtherBLUE CROSS BLUE SHIELD
1441HILHOtherNEIGHBORHOOD HEALTH