Healthcare Provider Details

I. General information

NPI: 1285742569
Provider Name (Legal Business Name): CYRIL BLAVO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR
DAVIE FL
33328-2018
US

IV. Provider business mailing address

3200 S UNIVERSITY DR ASSEMBLY BUIDLING 2, SUITE 202
DAVIE FL
33328-2018
US

V. Phone/Fax

Practice location:
  • Phone: 954-937-6764
  • Fax: 954-262-1172
Mailing address:
  • Phone: 954-262-4346
  • Fax: 954-262-1172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS5458
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: