Healthcare Provider Details

I. General information

NPI: 1093638827
Provider Name (Legal Business Name): DANIEL ALEXANDER POLANSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 BELMONT AVE
LOS ANGELES CA
90026-4126
US

IV. Provider business mailing address

602 BELMONT AVE
LOS ANGELES CA
90026-4126
US

V. Phone/Fax

Practice location:
  • Phone: 443-621-6783
  • Fax:
Mailing address:
  • Phone: 443-621-6783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: