Healthcare Provider Details

I. General information

NPI: 1326511395
Provider Name (Legal Business Name): ROBERTO CARLOS BLANCO DNP, CRNA, ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE STE 75
MIAMI FL
33136-1003
US

IV. Provider business mailing address

14470 SW 162ND ST
MIAMI FL
33177-1714
US

V. Phone/Fax

Practice location:
  • Phone: 305-689-5792
  • Fax: 305-689-1089
Mailing address:
  • Phone: 786-219-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN9275537
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11000864
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0131254
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9275537
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN9275537
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: