Provider Demographics
NPI:1366140873
Name:BLANCO, KATTIA (MD)
Entity type:Individual
Prefix:DR
First Name:KATTIA
Middle Name:
Last Name:BLANCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATTIA
Other - Middle Name:
Other - Last Name:BLANCO LORIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2238 SOUTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-3845
Mailing Address - Country:US
Mailing Address - Phone:404-775-4390
Mailing Address - Fax:
Practice Address - Street 1:212 S FLA ST
Practice Address - Street 2:
Practice Address - City:BUSHNELL
Practice Address - State:FL
Practice Address - Zip Code:33513-6703
Practice Address - Country:US
Practice Address - Phone:404-775-4390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1642208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice