Provider Demographics
NPI:1891153466
Name:BLANC, RICARDO
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:BLANC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6412 N UNIVERSITY DR
Mailing Address - Street 2:#114
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4055
Mailing Address - Country:US
Mailing Address - Phone:954-726-6722
Mailing Address - Fax:954-726-6723
Practice Address - Street 1:6412 N UNIVERSITY DR
Practice Address - Street 2:#114
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4055
Practice Address - Country:US
Practice Address - Phone:954-726-6722
Practice Address - Fax:954-726-6723
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide