MEDICARE: SALVADOR BLANCO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	57188	NM

General Provider Information

NPI Number	:	1134011604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALVADOR BLANCO

Provider Business Mailing Address
First Line	:	6569 WINDING RIDGE LOOP
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-3191
Country	:	US
Telephone Number	:	505-501-5953
Fax Number	:

Provider Business Practice Location Address
First Line	:	6569 WINDING RIDGE LOOP
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-3191
Country	:	US
Telephone Number	:	505-501-5953
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2025
Last Update Date	:	01/12/2026

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Directions to “ SALVADOR BLANCO ” Practice Location

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