Provider Demographics
NPI:1679743306
Name:MERCEDES GONZALEZ BLANCO MD PA
Entity type:Organization
Organization Name:MERCEDES GONZALEZ BLANCO MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-223-9044
Mailing Address - Street 1:8356 SW 40TH ST STE H
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3356
Mailing Address - Country:US
Mailing Address - Phone:305-223-9044
Mailing Address - Fax:305-223-9045
Practice Address - Street 1:8356 SW 40TH ST STE H
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3356
Practice Address - Country:US
Practice Address - Phone:305-223-9044
Practice Address - Fax:305-223-9045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD78884Medicare UPIN
FL95123Medicare PIN