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Dr. Lily Blascoa Blascoa-Ritterbeck

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NPI Number Detailed Information

Provider Information:

Name: Dr. Lily Blascoa Blascoa-Ritterbeck
Gender: F
Provider License Number If Given: ME42084

NPI Information:

NPI: 1689673287
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 7/18/2005

Last Update Date: 7/8/2007

Provider Business Mailing Address:

Address: 1220 WILLIS AVE
Daytona Beach, FL 32114
Phone Number: 3862363200
Fax Number: 3862260492

Provider Business Practice Location Address:

Address: 1220 WILLIS AVE
Daytona Beach, FL 32114
Phone Number: 3862363200
Fax Number: 3862260492

Provider Taxonomy:

Primary: 2084P0800X
Secondary (if any):
State: FL

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