MEDICARE: ANDRES POLANCO MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA61108	FL

General Provider Information

NPI Number	:	1902109218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRES POLANCO MA

Provider Business Mailing Address
First Line	:	1140 W 50TH ST STE 200A
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3438
Country	:	US
Telephone Number	:	305-818-2444
Fax Number	:	305-825-5200

Provider Business Practice Location Address
First Line	:	1140 W 50TH ST STE 200A
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3438
Country	:	US
Telephone Number	:	305-818-2444
Fax Number	:	305-825-5200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2010
Last Update Date	:	12/08/2010

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Directions to “ ANDRES POLANCO MA” Practice Location

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