Healthcare Provider Details

I. General information

NPI: 1457914343
Provider Name (Legal Business Name): YIARA S. BLANCO, PSY.D. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14448 BRUCE B DOWNS BLVD
TAMPA FL
33613-2612
US

IV. Provider business mailing address

14448 BRUCE B DOWNS BLVD
TAMPA FL
33613-2612
US

V. Phone/Fax

Practice location:
  • Phone: 813-701-2471
  • Fax: 813-701-2471
Mailing address:
  • Phone: 813-701-2471
  • Fax: 813-701-2471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. YIARA S BLANCO
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 813-701-2471