Provider Demographics
NPI:1881682953
Name:ABELLA-BLANCO, MIMI (MD)
Entity Type:Individual
Prefix:
First Name:MIMI
Middle Name:
Last Name:ABELLA-BLANCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 SW 72ND ST
Mailing Address - Street 2:SUITE 351
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3012
Mailing Address - Country:US
Mailing Address - Phone:305-273-1200
Mailing Address - Fax:305-273-1400
Practice Address - Street 1:10300 SW 72ND ST
Practice Address - Street 2:SUITE 351
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3012
Practice Address - Country:US
Practice Address - Phone:305-273-1200
Practice Address - Fax:305-273-1400
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65990208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375928800Medicaid
FL375928800Medicaid