Provider Demographics
NPI:1699716670
Name:BLANCO, CARLOS ALBERTO (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ALBERTO
Last Name:BLANCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3845 SW 148TH TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3313
Mailing Address - Country:US
Mailing Address - Phone:305-761-9392
Mailing Address - Fax:954-842-4630
Practice Address - Street 1:3845 SW 148TH TER
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3313
Practice Address - Country:US
Practice Address - Phone:305-761-9392
Practice Address - Fax:954-842-4630
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71266207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG37922Medicare UPIN