MEDICARE: DEBRA ANN BLANCO PA-C

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	363A00000X	Physician Assistant	PA 14845	CA

General Provider Information

NPI Number	:	1740372366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA ANN BLANCO PA-C

Provider Business Mailing Address
First Line	:	437 N EUCLID AVE
Second Line	:	SUITE A
City	:	ONTARIO
State	:	CA
Zip	:	91762-3456
Country	:	US
Telephone Number	:	909-988-2555
Fax Number	:	909-988-4447

Provider Business Practice Location Address
First Line	:	437 N EUCLID AVE
Second Line	:	SUITE A
City	:	ONTARIO
State	:	CA
Zip	:	91762-3456
Country	:	US
Telephone Number	:	909-988-2555
Fax Number	:	909-988-4447

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	07/08/2007

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