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General NPI Number Information
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NPI Number | 1619017761
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Entity Type | Individual
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Provider Name | HILDEBERT A BLASCO MD
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Gender | Male
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 10/04/2012
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Provider Practice Location Address
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Address Line | 401 BLOQUE 139 # 10 VILLA CAROLINA
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City | CAROLINA
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State | PR
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Zip | 00976
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Country | US
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Telephone | 787-769-5842
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Fax |
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Provider Business Mailing Address
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Address Line | LB 18 VIA MALLORCA LA ANTIGUA ENCANTADA
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976-6101
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Country | US
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Telephone | 787-769-5842
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 14656
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License Number State | PR
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