MEDICARE: IRAIDA BLANCHE-VEGA

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	363L00000X	Nurse Practitioner	ARNP2209322	FL

General Provider Information

NPI Number	:	1134594260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRAIDA BLANCHE-VEGA

Provider Business Mailing Address
First Line	:	3837 SW 99TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-3907
Country	:	US
Telephone Number	:	305-552-1717
Fax Number	:	305-552-1782

Provider Business Practice Location Address
First Line	:	3837 SW 99TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-3907
Country	:	US
Telephone Number	:	305-552-1717
Fax Number	:	305-552-1782

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

Provider Enumeration Date	:	12/01/2015
Last Update Date	:	12/01/2015

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Directions to “ IRAIDA BLANCHE-VEGA ” Practice Location

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