Healthcare Provider Details

I. General information

NPI: 1326299389
Provider Name (Legal Business Name): WILMARIE JEAN BRUCKMAN BLANCO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UPR MEDICAL SCIENCES CAMPUS SUITE 209
SAN JUAN PR
00936
US

IV. Provider business mailing address

874 CALLE HEBRIDES
SAN JUAN PR
00924-1732
US

V. Phone/Fax

Practice location:
  • Phone: 787-756-4020
  • Fax:
Mailing address:
  • Phone: 787-276-8183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number18158
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12043
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: