1437165412 NPI number — DR. MERCEDES GONZALEZ BLANCO MD

Table of content: DR. MERCEDES GONZALEZ BLANCO MD (NPI 1437165412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437165412 NPI number — DR. MERCEDES GONZALEZ BLANCO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ BLANCO
Provider First Name:
MERCEDES
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1437165412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8356 SW 40TH ST STE H
Provider Second Line Business Mailing Address:
BOX 016960 M851
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33155-3356
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-223-9044
Provider Business Mailing Address Fax Number:
305-223-9045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8356 SW 40 TH ST SUITE H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-223-9044
Provider Business Practice Location Address Fax Number:
305-223-9045
Provider Enumeration Date:
07/31/2006

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: 2084P0800X , with the licence number:  ME27425 , 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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