MR. LUIS A BLANCO (NPI# 1043532179) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043532179 |
| Entity Type | Individual |
| Full Name | MR. LUIS A BLANCO |
| Credential | PAC |
| Practice Address |
10211 Roosevelt Ave Corona NY 11368-2331 |
| Mailing Address |
25 Jackson Ave White Plains NY 10606-2216 |
| Practice Telephone | 7188981386 |
| Practice Fax Number | 7188981093 |
| Mailing Telephone | 9175726810 |
| Enumeration Date | 2010-02-16 |
| Last Update Date | 2018-04-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
005075-1 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | LICENSE NO | 005075-1 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558580522 | Luis A Blanco | Pediatrics | 8752 Sw 8th St, Miami, FL 33174-3201 | 2007-04-25 |
| 1790134641 | Luis Manuel Blanco | Nurse Practitioner | 1995 E Oakland Park Blvd Ste 250, Ft Lauderdale, FL 33306-1149 | 2016-06-10 |
| 1679739262 | Luis Z Blanco Jr. | Pathology | 251 E Huron St, Feinberg 7-325, Chicago, IL 60611-2908 | 2008-08-02 |
| 1730254855 | Luis J. Blanco | Dentist | 1201 N Stonewall Ave, Room 494, Oklahoma City, OK 73117-1214 | 2006-11-22 |
| 1285714212 | Luis A. Blanco | Dentist | 220 Westchester Ave, Port Chester, NY 10573-4557 | 2006-10-16 |
| Street Address |
10211 ROOSEVELT AVE |
| City | CORONA |
| State | NY |
| Zip Code | 11368-2331 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376538553 | Cervantes B Pena | Pediatrics | 10211 Roosevelt Ave, Corona, NY 11368-2331 | 2005-09-14 |
| 1912487588 | E T Medical Pllc | Pediatrics | 10211 Roosevelt Ave, Corona, NY 11368-2331 | 2018-08-14 |
| 1821518978 | Lindsay Raveena Virdee | Registered Nurse | 10211 Roosevelt Ave, Corona, NY 11368-2331 | 2017-06-20 |
| 1942730395 | Sharon Fortgang | Registered Nurse | 10211 Roosevelt Ave, Corona, NY 11368-2331 | 2017-06-19 |
| 1174058200 | Yeh Ling Yiin Dillon | Pediatrics | 10211 Roosevelt Ave, Corona, NY 11368-2331 | 2017-04-26 |
| 1861886723 | Hector M. Florimon | Pediatrics | 10211 Roosevelt Ave, Corona, NY 11368-2331 | 2015-03-27 |
| 1437556370 | John B Halkias Physician PC | Clinic/Center | 10211 Roosevelt Ave, Corona, NY 11368-2331 | 2014-11-20 |
| 1417361122 | Maria C. Coe, Msrd,cdn,pc | Clinic/Center | 10211 Roosevelt Ave, Corona, NY 11368-2331 | 2014-06-20 |
| 1194151712 | Paul Edward Gonzalez | Pediatrics | 10211 Roosevelt Ave, Corona, NY 11368-2331 | 2013-09-16 |
| 1124453105 | Maria Gabriela Ponce Garcia | Internal Medicine | 10211 Roosevelt Ave, Corona, NY 11368-2331 | 2013-09-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760014039 | Marukh Naeem | Behavioral Analyst | 11119a Roosevelt Ave, Apt 2r, Apt 2r, Corona, NY 11368 | 2020-02-05 |
| 1164072989 | Tonyia Michelle Madison | Counselor | 34-10 108 Street, Corona, Queens, NY 11368 | 2019-09-13 |
| 1962987347 | Sinead Anel Ulloa | Speech-Language Pathologist | 10420 37th Rd, Corona, NY 11368 | 2018-10-01 |
| 1245725779 | Bracha Namdar | Optometrist | 103-06 Roosevelt Ave, Corona, NY 11368 | 2018-06-27 |
| 1548758220 | Karina Elizabeth Carrasco | Specialist | 96- 32 46th Ave, Corona, NY 11368 | 2018-04-27 |
| 1134634033 | Nicole Iuculano | Speech-Language Pathologist | 43-18 97th Place, Corona, NY 11368 | 2017-12-13 |
| 1558880831 | Abenaa Nyame Danquah | Registered Nurse | 55-25 98th Place, Apt 1k, Corona, NY 11368 | 2017-09-18 |
| 1063940443 | Brand Rx Pharmacy Corp | Pharmacy | 97-05 A 57th Avenue, Corona, NY 11368 | 2017-05-30 |
| 1427595909 | Richelle Krish Sumaoy Colmenares | Physical Therapist | 3744 104th St., Corona, New York City, NY 11368 | 2017-01-23 |
| 1235674342 | 39th Avenue Physical Therapy PC | Clinic/Center | 103-18c 39 Ave, Corona, NY 11368 | 2016-12-28 |
| Find all providers in zip 11368 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043677859 | Erika Crystal Reyes | Physician Assistant | 127 N Mckinley St Ste 101, Corona, CA 92879-6563 | 2016-01-25 |
| 1255710240 | Griselle Villar Ledesma | Physician Assistant | 10427 Corona Ave, Corona, NY 11368-2979 | 2015-05-22 |
| 1558668772 | Jenna Lalas Eugenio | Physician Assistant | 2097 Compton Ave Ste 103, Corona, CA 92881 | 2011-02-24 |
| 1457660359 | Rudy Manuel Ramirez | Physician Assistant | 13355 Green Mountain Dr, Corona, CA 92883-6229 | 2010-09-27 |
| 1720311012 | Hugh Kling Berkley | Physician Assistant | 760 Washburn Ave Ste 5/6, Corona, CA 92882-3303 | 2009-09-17 |
| 1740420918 | Sean David Totten | Physician Assistant | 1492 Fairmont Dr, Corona, CA 92882 | 2009-03-02 |
| 1477745768 | Rose M Ruiz-flores | Physician Assistant | 1530 W 6th St Ste 109, Corona, CA 92882-2784 | 2007-08-10 |
| 1902097926 | Lansdale John Peters | Physician Assistant | 1231 Kendrick Ct, Corona, CA 92881-8226 | 2007-08-06 |
| 1891865747 | Phuong Anh Thi La | Physician Assistant | 2071 Compton Ave, Suite 102, Corona, CA 92881-7278 | 2006-11-08 |
| 1366525461 | Carina Julie-ann Moscoso | Physician Assistant | 2250 S. Main St., Suite 201, Corona, CA 92882-2536 | 2006-10-23 |
| Find all providers in CORONA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.