Healthcare Provider Details

I. General information

NPI: 1356894398
Provider Name (Legal Business Name): VIVIANA BLANCO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 CARR 2 STE 306
BAYAMON PR
00959-5065
US

IV. Provider business mailing address

273 CALLE HONDURAS APT 406
SAN JUAN PR
00917-2809
US

V. Phone/Fax

Practice location:
  • Phone: 787-919-7799
  • Fax:
Mailing address:
  • Phone: 787-313-2143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number22323
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34226
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: