Provider Demographics
NPI:1912610486
Name:SANCHEZ-DOMINGUEZ, BLANCA G (CPT)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:G
Last Name:SANCHEZ-DOMINGUEZ
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 NEW BRIGHTON BLVD STE 104-221
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1248
Mailing Address - Country:US
Mailing Address - Phone:612-770-3513
Mailing Address - Fax:
Practice Address - Street 1:1400 S 2ND ST APT C104
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1077
Practice Address - Country:US
Practice Address - Phone:612-770-3513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNN22106286202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology