Healthcare Provider Details

I. General information

NPI: 1730600586
Provider Name (Legal Business Name): CLARISS LOVELLE ALMODAL BLANCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 LENOX AVE
NEW YORK NY
10037-1802
US

IV. Provider business mailing address

506 LENOX AVENUE (MLK 17-110) HARLEM HOSPITAL
NEW YORK NY
10037
US

V. Phone/Fax

Practice location:
  • Phone: 212-939-4019
  • Fax:
Mailing address:
  • Phone: 212-939-4019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: