Healthcare Provider Details

I. General information

NPI: 1598694713
Provider Name (Legal Business Name): MS. JANETTE MARINA BLANCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13285 SW 36TH ST
MIAMI FL
33175-6904
US

IV. Provider business mailing address

13285 SW 36TH ST
MIAMI FL
33175-6904
US

V. Phone/Fax

Practice location:
  • Phone: 786-325-5556
  • Fax:
Mailing address:
  • Phone: 786-325-5556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number108590
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: