Provider Demographics
NPI:1477258036
Name:PRIETO, BLAS CHRISTIAN (DO)
Entity type:Individual
Prefix:DR
First Name:BLAS
Middle Name:CHRISTIAN
Last Name:PRIETO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5911 TOSCANA DR APT 1112
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-3499
Mailing Address - Country:US
Mailing Address - Phone:305-298-0963
Mailing Address - Fax:
Practice Address - Street 1:5911 TOSCANA DR APT 1112
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-3499
Practice Address - Country:US
Practice Address - Phone:305-298-0963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program