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1750377495

NPI Code Detail

MEDICARE: JULIETA G TABLANTE-BLANCO MD

MEDICARE: JULIETA G TABLANTE-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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	24437	NV
2	207ZC0500X	Cytopathology Physician	4301078930	MI

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750377495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIETA G TABLANTE-BLANCO MD

Provider Business Mailing Address
First Line	:	1355 RIVER BEND DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-4915
Country	:	US
Telephone Number	:	512-439-1600
Fax Number	:	844-751-9263

Provider Business Practice Location Address
First Line	:	7455 W WASHINGTON AVE STE 301
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-4340
Country	:	US
Telephone Number	:	702-732-3441
Fax Number	:

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	07/11/2024

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Directions to “ JULIETA G TABLANTE-BLANCO MD” Practice Location

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