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NPI Code Detail

MEDICARE: VANESSA BLANCO

MEDICARE:   VANESSA  BLANCO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1043035579
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANESSA BLANCO
Provider Business Mailing Address
First Line : 2295 RENAISSANCE DR STE D
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-6758
Country : US
Telephone Number : 702-763-5379
Fax Number :
Provider Business Practice Location Address
First Line : 2295 RENAISSANCE DR STE D
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-6758
Country : US
Telephone Number : 702-763-5379
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2024
Last Update Date : 11/19/2024

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Directions to “ VANESSA BLANCO ” Practice Location

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