Provider Demographics
NPI:1285977793
Name:COSME-BLANCO, WILFREDO (MD,PHD)
Entity type:Individual
Prefix:
First Name:WILFREDO
Middle Name:
Last Name:COSME-BLANCO
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4864
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-4864
Mailing Address - Country:US
Mailing Address - Phone:787-658-6133
Mailing Address - Fax:
Practice Address - Street 1:47 AVE SEVERIANO CUEVAS STE 1
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5751
Practice Address - Country:US
Practice Address - Phone:787-658-6133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19335208000000X, 207K00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology