Healthcare Provider Details

I. General information

NPI: 1194137257
Provider Name (Legal Business Name): HEATHER POLANCO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2014
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17848 SKY PARK CIR STE B
IRVINE CA
92614-6135
US

IV. Provider business mailing address

17848 SKY PARK CIR STE B
IRVINE CA
92614-6135
US

V. Phone/Fax

Practice location:
  • Phone: 949-418-7167
  • Fax:
Mailing address:
  • Phone: 949-418-7167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-12-11476
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: