Healthcare Provider Details

I. General information

NPI: 1285580845
Provider Name (Legal Business Name): MR. EDDIE BLANCO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 UNION ST
RED BLUFF CA
96080-3121
US

IV. Provider business mailing address

1260 UNION ST
RED BLUFF CA
96080-3121
US

V. Phone/Fax

Practice location:
  • Phone: 530-727-1681
  • Fax:
Mailing address:
  • Phone: 530-727-1681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number176E79302B
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: