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General NPI Number Information
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NPI Number | 1326299389
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Entity Type | Individual
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Provider Name | WILMARIE JEAN BRUCKMAN BLANCO M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/08/2008
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Last Update Date | 10/08/2008
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Provider Practice Location Address
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Address Line | UPR MEDICAL SCIENCES CAMPUS SUITE 209
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City | SAN JUAN
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State | PR
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Zip | 00936
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Country | US
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Telephone | 787-756-4020
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Fax |
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Provider Business Mailing Address
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Address Line | 874 CALLE HEBRIDES
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City | SAN JUAN
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State | PR
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Zip | 00924-1732
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Country | US
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Telephone | 787-276-8183
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 12043
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License Number State | PR
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