Provider Demographics
NPI:1144665894
Name:BLANCO, NOEL (DO)
Entity type:Individual
Prefix:DR
First Name:NOEL
Middle Name:
Last Name:BLANCO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 MILL ST # M14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-7205
Practice Address - Street 1:10085 DOUBLE R BLVD STE 325B
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-4832
Practice Address - Country:US
Practice Address - Phone:775-982-2280
Practice Address - Fax:775-982-7205
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1303208D00000X
NVDO3383208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice