Provider Demographics
NPI:1902987688
Name:BLANCO, EMILIO ARMANDO (MD)
Entity Type:Individual
Prefix:
First Name:EMILIO
Middle Name:ARMANDO
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 1:1150 N 35TH AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5424
Mailing Address - Country:US
Mailing Address - Phone:954-961-7718
Mailing Address - Fax:954-961-0163
Practice Address - Street 1:1150 N 35TH AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5424
Practice Address - Country:US
Practice Address - Phone:954-961-7718
Practice Address - Fax:954-961-0163
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84586207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG69280Medicare UPIN
FLU5204ZMedicare ID - Type Unspecified