Active NPI
Roseanne Sofia Evangelista Blanco, OTR/L
- Occupational Therapist
- Santa Monica, CA
National Provider Identifier
1043042526
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 26770
- Practice address
- 1932 14TH St
Santa Monica, CA 90404-4605 - Phone
- (310) 344-2276
- NPI assigned
- Aug 14, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 26770 | CA | Primary |
Addresses
Primary practice location
1932 14TH St
Santa Monica, CA 90404-4605
Mailing address
3822 Montclair St
Los Angeles, CA 90018-2363
Phone (808) 451-7049
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26770 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1723593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723593600000",
"number": "1043042526",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3822 MONTCLAIR ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900182363",
"telephone_number": "808-451-7049"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1932 14TH ST",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904044605",
"telephone_number": "310-344-2276"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLANCO",
"first_name": "ROSEANNE SOFIA",
"middle_name": "EVANGELISTA",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-14",
"last_updated": "2024-08-14",
"certification_date": "2024-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "26770",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Monica, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.