Malynie D Blanco Burgos, M.D.
Individual provider Active NPI Family Medicine Physician · Ponce, PR
NPI 1750339701 · NPPES record last updated Mar 29, 2022
Key facts
- NPI
- 1750339701
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 13881 (PR)
- Practice address
- Estancias del Golf Club
# 101 Miguel Rivera Texidor Street
Ponce, PR 00730 - Phone
- (787) 844-5496
- Fax
- (787) 840-0052
- NPI assigned
- May 4, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13881 | PR | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Primary Medical Group,C.S.P. | Family Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 13881 | PR | Yes |
Addresses
Primary practice location
Estancias del Golf Club
# 101 Miguel Rivera Texidor Street
Ponce, PR 00730
Mailing address
Estancias del Golf Club
# 101 Miguel Rivera Texidor Street
Ponce, PR 00730
Phone (787) 844-5496
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 142273 | Other | PR | NARCOTIC STATE LISENCE |
| 13881 | Other | PR | MEDICAL LISENCE |
| BB7545695 | Other | PR | NARCOTI FEDERAL LISENCE |
Other providers in Ponce, PR
- Alexandra Binaei
- Bio-Medical Applications of Arecibo, Inc.
- Bio-Medical Applications of Ponce, Inc.
- Bio-Medical Applications of Puerto Rico, Inc.
- Juana D Bisono-Bido
- Jose Angel Blanco de Jesus Sr.
- Edda Maria Blanco Rodriguez
- Arturo Luis Blanco-Plard
- Ivonne Magaly Blasini
- Ricardo J Blondet Vissepo
All providers in Ponce, PR · Family Medicine Physician in Puerto Rico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 29, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.