Provider Demographics
NPI:1033911268
Name:BLANCO, BRENDA VICTORIA (DOULA)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:VICTORIA
Last Name:BLANCO
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 TIMBERLAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-0258
Mailing Address - Country:US
Mailing Address - Phone:702-338-4036
Mailing Address - Fax:
Practice Address - Street 1:3720 TIMBERLAKE DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-0258
Practice Address - Country:US
Practice Address - Phone:702-338-4036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula