Provider Demographics
NPI:1700074697
Name:POMALES, BLANCA LIZ (MS, SLP)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:LIZ
Last Name:POMALES
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10455 SPARROW LANDING WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6010
Mailing Address - Country:US
Mailing Address - Phone:407-249-5614
Mailing Address - Fax:407-384-6965
Practice Address - Street 1:10455 SPARROW LANDING WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6010
Practice Address - Country:US
Practice Address - Phone:407-249-5614
Practice Address - Fax:407-384-6965
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 9083235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist