Provider Demographics
NPI:1922424902
Name:BLANCO FAMILY MEDICINE INC.
Entity type:Organization
Organization Name:BLANCO FAMILY MEDICINE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:626-915-3000
Mailing Address - Street 1:380 W BADILLO ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1827
Mailing Address - Country:US
Mailing Address - Phone:626-915-3000
Mailing Address - Fax:626-915-3004
Practice Address - Street 1:380 W BADILLO ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1827
Practice Address - Country:US
Practice Address - Phone:626-915-3000
Practice Address - Fax:626-915-3004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0751476261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care