Provider Demographics
NPI:1316241235
Name:BLANQUEL, GLORIA LIZETTE
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:LIZETTE
Last Name:BLANQUEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-2845
Mailing Address - Country:US
Mailing Address - Phone:760-337-5088
Mailing Address - Fax:760-337-7885
Practice Address - Street 1:1295 W STATE ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2845
Practice Address - Country:US
Practice Address - Phone:760-337-5088
Practice Address - Fax:760-337-7885
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor