Basic Information
| Provider Information | |||||||||
| NPI: | 1558887612 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIERRE | ||||||||
| FirstName: | BLANDINE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 63-31 CALLE 52 | ||||||||
| Address2: | |||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009614449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457290938 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15 CALLE DR BASORA N | ||||||||
| Address2: | |||||||||
| City: | MAYAGUEZ | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006804833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878340101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2017 | ||||||||
| LastUpdateDate: | 03/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 19772 | PR | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.