Provider Demographics
NPI:1316232549
Name:BLANCO, JANNETH DE LOS ANGELES
Entity type:Individual
Prefix:MISS
First Name:JANNETH
Middle Name:DE LOS ANGELES
Last Name:BLANCO
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 1:4273 27TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-8962
Mailing Address - Country:US
Mailing Address - Phone:239-362-6378
Mailing Address - Fax:
Practice Address - Street 1:4273 27TH AVE NE
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34120-8962
Practice Address - Country:US
Practice Address - Phone:239-362-6378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 63366225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist