Nubia Auxiliadora Blanco, DDS
Individual provider Active NPI General Practice Dentistry · Diamond Bar, CA
NPI 1982894804 · NPPES record last updated May 13, 2020
Key facts
- NPI
- 1982894804
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 42634 (CA)
- Practice address
- 1410 Spruce Tree Dr
Diamond Bar, CA 91765-2571 - Phone
- (909) 612-0719
- Fax
- (909) 456-0607
- NPI assigned
- Jul 26, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151221000674 | CA | Order and Referring Only - Oral Surgery |
5496056244 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 42634 | CA | Yes |
Addresses
Primary practice location
1410 Spruce Tree Dr
Diamond Bar, CA 91765-2571
Mailing address
1410 Spruce Tree Dr
Diamond Bar, CA 91765-2571
Phone (909) 612-0719
Other providers in Diamond Bar, CA
- Bhavneet Kaur Bhogal
- Bicoastal Medical Transportation, LLC
- Bill Coker DDS
- Jamie Billings
- Taylor Woodbury Bladh
- Bo Yu DDS Inc
- Sravanthi Bolla
- Mary Sowjanya Bonige
- Boules Chiropractic Inc
- Gregory Joseph Boules
All providers in Diamond Bar, CA · General Practice Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.