MEDICARE: JESSICA MARIE 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
1	225400000X	Rehabilitation Practitioner		CA

General Provider Information

NPI Number	:	1437028677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MARIE BLANCO

Provider Business Mailing Address
First Line	:	PO BOX 15408
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93406-5408
Country	:	US
Telephone Number	:	805-540-6500
Fax Number	:	805-540-6501

Provider Business Practice Location Address
First Line	:	203 BRIDGE ST
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-3311
Country	:	US
Telephone Number	:	805-305-3724
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2025
Last Update Date	:	12/19/2025

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