Provider Demographics
NPI:1588348932
Name:BLANES, MARIA ELISA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ELISA
Last Name:BLANES
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 1:405 AVE ESMERALDA STE 2
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4466
Mailing Address - Country:US
Mailing Address - Phone:787-364-7172
Mailing Address - Fax:
Practice Address - Street 1:SAN JUAN HEALTH CENTER
Practice Address - Street 2:150 AVE DE DIEGO PRIMER PISO
Practice Address - City:SAN JUAN PR
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-725-8073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist