Provider Demographics
NPI:1194951376
Name:CARBALLIDO, BLANCA PATRICIA
Entity type:Individual
Prefix:MRS
First Name:BLANCA
Middle Name:PATRICIA
Last Name:CARBALLIDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 AMERICUS AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-5019
Mailing Address - Country:US
Mailing Address - Phone:631-803-2895
Mailing Address - Fax:
Practice Address - Street 1:932 AMERICUS AVE
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-5019
Practice Address - Country:US
Practice Address - Phone:631-803-2895
Practice Address - Fax:631-803-2895
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY533381163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse