Healthcare Provider Details

I. General information

NPI: 1669642401
Provider Name (Legal Business Name): JESSICA BLANCO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 W CHANDLER BLVD STE.#B-13
CHANDLER AZ
85226-3683
US

IV. Provider business mailing address

5505 W CHANDLER BLVD STE.#B-13
CHANDLER AZ
85226-3683
US

V. Phone/Fax

Practice location:
  • Phone: 480-361-4780
  • Fax: 480-361-4781
Mailing address:
  • Phone: 480-361-4780
  • Fax: 480-361-4781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA BLANCO
Title or Position: OWNER
Credential: MD
Phone: 480-361-4780