Provider Demographics
NPI:1386694875
Name:VNL MEDICAL ASSOCIATION CORP
Entity type:Organization
Organization Name:VNL MEDICAL ASSOCIATION CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-262-1128
Mailing Address - Street 1:1705 SW 83RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1156
Mailing Address - Country:US
Mailing Address - Phone:305-262-1128
Mailing Address - Fax:305-262-6935
Practice Address - Street 1:237 NW 12TH AVE
Practice Address - Street 2:SUITE A-E
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33128-1080
Practice Address - Country:US
Practice Address - Phone:305-324-0211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40226Medicare ID - Type UnspecifiedPROVIDER NUMBER