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General NPI Number Information
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NPI Number | 1356390371
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Entity Type | Individual
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Provider Name | RICARDO E. BLANCO M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 03/23/2011
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Provider Practice Location Address
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Address Line | 1203 S TYLER ST SUITE 200
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City | COVINGTON
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State | LA
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Zip | 70433-2353
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Country | US
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Telephone | 985-892-9143
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Fax | 985-892-9656
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Provider Business Mailing Address
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Address Line | 1203 S TYLER ST SUITE 200
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City | COVINGTON
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State | LA
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Zip | 70433-2353
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Country | US
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Telephone | 985-892-9143
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Fax | 985-892-9656
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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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 10460
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 10460
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License Number State | LA
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