1093525248 NPI number — BELEN MERCEDES BLANCO SALAZAR NP

Table of content: BELEN MERCEDES BLANCO SALAZAR NP (NPI 1093525248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093525248 NPI number — BELEN MERCEDES BLANCO SALAZAR NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLANCO SALAZAR
Provider First Name:
BELEN
Provider Middle Name:
MERCEDES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093525248
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1028 WILLA LAKE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVIEDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32765-6425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-640-1373
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1520 CITRUS MEDICAL CT # B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCOEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34761-4547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-216-2121
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  11037932 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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