Mata, John Michael Blanco
Mata, John Michael Blanco is an sole proprietor health care provider with primary practice located at 3250 Gateway Blvd Ste 112 , Prescott AZ 86303-6856. He recently has 5 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Acute Care, Physician Assistants & Advanced Practice Nursing Providers / Adult Health, Physician Assistants & Advanced Practice Nursing Providers / Critical Care Medicine, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Gerontology. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is his primary health care specialty. Mata, John Michael Blanco can be contacted via phone (708) 248-0049.Contact Information
Primary practice address
3250 Gateway Blvd Ste 112
Prescott AZ 86303-6856
Phone: (708) 248-0049
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Acute Care | 363LA2100X | 267971 | Arizona |
| Physician Assistants & Advanced Practice Nursing Providers / Adult Health | 363LA2200X | 267971 | Arizona |
| Physician Assistants & Advanced Practice Nursing Providers / Critical Care Medicine | 363LC0200X | 267971 | Arizona |
| Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X | 267971 | Arizona |
| Physician Assistants & Advanced Practice Nursing Providers / Gerontology | 363LG0600X | 267971 | Arizona |
Profile Details
| NPI number | 1639871247 |
|---|---|
| LBN Legal business name | Mata, John Michael Blanco |
| Credentials | Nurse Practitioner (NP) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 20th, 2023 |
| Last updated | Jan 31st, 2024 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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