Healthcare Provider Details

I. General information

NPI: 1780645176
Provider Name (Legal Business Name): ANDREW D POLANSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 E VALLEY PKWY SUITE 100
ESCONDIDO CA
92025-3363
US

IV. Provider business mailing address

PO BOX 462750
ESCONDIDO CA
92046-2750
US

V. Phone/Fax

Practice location:
  • Phone: 760-739-5400
  • Fax: 760-739-8471
Mailing address:
  • Phone: 760-520-8500
  • Fax: 760-520-8523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG45468
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberG45468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: