Provider Demographics
NPI:1194609263
Name:GORDILLO SUAREZ, BLANCA MERCEDES (SA-C)
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:MERCEDES
Last Name:GORDILLO SUAREZ
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10097 COSTA DEL SOL BLVD
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2917
Mailing Address - Country:US
Mailing Address - Phone:305-469-4668
Mailing Address - Fax:
Practice Address - Street 1:10097 COSTA DEL SOL BLVD
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2917
Practice Address - Country:US
Practice Address - Phone:305-469-4668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-02
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-551246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant