Healthcare Provider Details

I. General information

NPI: 1003669789
Provider Name (Legal Business Name): NIA BLANCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8785 SW 165TH AVE STE 202B
MIAMI FL
33193-5828
US

IV. Provider business mailing address

7830 SW 15TH ST
MIAMI FL
33144-5206
US

V. Phone/Fax

Practice location:
  • Phone: 305-900-3787
  • Fax:
Mailing address:
  • Phone: 786-376-4355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: