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1568625200

NPI Code Detail

MEDICARE: CARLOS JAVIER BLANCO MD

MEDICARE: CARLOS JAVIER BLANCO MD

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	208000000X	Pediatrics Physician	ME111671	FL
2	2080P0202X	Pediatric Cardiology Physician	E-6685	AR
3	2080P0202X	Pediatric Cardiology Physician	57 014261	OH
4	2080P0202X	Pediatric Cardiology Physician	ME111671	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ME111671	OTHER	FL	MEDICAL LICENSE

General Provider Information

NPI Number	:	1568625200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS JAVIER BLANCO MD

Provider Business Mailing Address
First Line	:	2501 N ORANGE AVE STE 310
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4642
Country	:	US
Telephone Number	:	407-303-2001
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 N ORANGE AVE STE 310
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4642
Country	:	US
Telephone Number	:	407-303-2001
Fax Number	:

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

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	01/27/2023

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Directions to “ CARLOS JAVIER BLANCO MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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