Coby Jeanne Patrice Blanco, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

0506269 Issued in NV

Practice address

3121 Las Vegas Blvd S
Las Vegas, NV 89109-1967

Phone

(702) 770-3751

NPI assigned

Jul 28, 2014

Last updated

Feb 20, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jeanne Patrice Vandenberg Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582156800000",
    "number": "1881002392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10758 VESTONE ST",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891410480",
            "telephone_number": "702-379-8421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3121 LAS VEGAS BLVD S",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891091967",
            "telephone_number": "702-770-3751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANCO",
        "first_name": "COBY",
        "middle_name": "JEANNE PATRICE",
        "credential": "LAT, ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-28",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NV",
            "license": "0506269",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEANNE",
            "last_name": "VANDENBERG",
            "middle_name": "PATRICE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amber Blanco
• Arlene Salazar Blanco, APRN,FNP-BC, FNP-C
• Brenda Victoria Blanco, DOULA
• Brianna Thereze Salazar Blanco I
• Carmen Blanco
• Dione Blanco
• Douglas Manuel Blanco
• Emmanuel Blanco
• Francis Blanco
• Gerard Blanco

• Athletic Trainer in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Athletic Trainer in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.