Doctor Name: | MR. MARIO POLANCO |
NPI Number: | 1073640587 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | B.S, DEGREE |
License Number: | PT 11680 |
Business Practice Address: | 5301 Whittier Blvd Atrium Suite Los Angeles, CA - 900224038 |
Business Phone Number: | 3238877458 |
Business Fax Number: | 3238878288 |
Mailing Address: | Po Box 45195, LOS ANGELES |
State: | CA |
Postal Code: | 900450191 |
Phone Number: | 3238877458 |
Fax Number: | 3238878288 |
NPI Enumeration Date: | 02/28/2007 |
NPI Last Update Date: | 12/22/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | PT 11680 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |