Healthcare Provider Details

I. General information

NPI: 1578411609
Provider Name (Legal Business Name): BLANCA BALBINO TIRADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 COCHRANE CIR BLDG 7495
FT CARSON CO
80913-4603
US

IV. Provider business mailing address

18732 IMPERIAL EAGLE LN
ELGIN TX
78621-4224
US

V. Phone/Fax

Practice location:
  • Phone: 719-317-9237
  • Fax:
Mailing address:
  • Phone: 512-992-3393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: