Provider Demographics
NPI:1013048891
Name:BLANCO, CARMEN JULIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:JULIA
Last Name:BLANCO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. LOS REYES
Mailing Address - Street 2:#29 CALLE ORO
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-2858
Mailing Address - Country:US
Mailing Address - Phone:787-810-1040
Mailing Address - Fax:787-260-1059
Practice Address - Street 1:URB. LOS REYES #29 CALLE ORO
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-2858
Practice Address - Country:US
Practice Address - Phone:787-810-1040
Practice Address - Fax:787-260-1059
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22433163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1868135OtherDRIVERS LICENSE