Provider Demographics
NPI:1265411607
Name:BLANCO BLASCO, GOAR (DC)
Entity type:Individual
Prefix:DR
First Name:GOAR
Middle Name:
Last Name:BLANCO BLASCO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 WINSTON CHURCHHILL
Mailing Address - Street 2:MAIL STATION 655
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-0001
Mailing Address - Country:US
Mailing Address - Phone:787-751-9147
Mailing Address - Fax:787-753-4641
Practice Address - Street 1:576 CALLE CESAR GONZALEZ
Practice Address - Street 2:STE 501
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-751-9147
Practice Address - Fax:787-753-4641
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0264111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR074005OtherBLUE CROSS BLUE SHIELD
CP1001OtherPAN AMERICAN LIFE
PR9260158OtherHUMANA INS PR
PR83203OtherPR WORKERS COMP
1388OtherFIRST MEDICAL
PR51229BLOtherBLUE CROSS BLUE SHIELD PR
PR9260158OtherHUMANA INS PR
PR0035043Medicare ID - Type Unspecified