=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740471457
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTOPHER J. BLANCO DPM PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2007
-----------------------------------------------------
Last Update Date | 04/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 NW 57TH AVE STE 320
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33126-2087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-264-2632
-----------------------------------------------------
Fax | 305-266-2274
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 NW 57TH AVE STE 320
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33126-2087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-264-2632
-----------------------------------------------------
Fax | 305-266-2274
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CHRISTOPHER J BLANCO
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 305-264-2632
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | PO3186
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------