Provider Demographics
NPI:1306048897
Name:BLASINI, ILEANA ENID (MD)
Entity type:Individual
Prefix:
First Name:ILEANA
Middle Name:ENID
Last Name:BLASINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:F7 CALLE ECUADOR
Mailing Address - Street 2:URB. OASIS GDNS
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3424
Mailing Address - Country:US
Mailing Address - Phone:787-790-8726
Mailing Address - Fax:787-287-2290
Practice Address - Street 1:503 CALLE ROOSEVELT
Practice Address - Street 2:URB. LA CUMBRE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5608
Practice Address - Country:US
Practice Address - Phone:787-287-2290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR74592080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7459OtherSTATE LICENCE