Healthcare Provider Details

I. General information

NPI: 1689860314
Provider Name (Legal Business Name): LUISA BOZZO-POLANCO CNM, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11760 SW 40TH ST STE 518
MIAMI FL
33175-3598
US

IV. Provider business mailing address

11760 SW 40 ST #518
MIAMI FL
33175-3598
US

V. Phone/Fax

Practice location:
  • Phone: 305-553-2888
  • Fax: 305-553-0291
Mailing address:
  • Phone: 305-553-2888
  • Fax: 305-553-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP 2523572
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: