Healthcare Provider Details

I. General information

NPI: 1255585923
Provider Name (Legal Business Name): DANILO POLANCO PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2008
Last Update Date: 11/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5766 S SEMORAN BLVD
ORLANDO FL
32822-4818
US

IV. Provider business mailing address

5766 SOUTH SEMORAN BOULEVARD
ORLANDO FL
32822
US

V. Phone/Fax

Practice location:
  • Phone: 407-896-2323
  • Fax: 407-896-7760
Mailing address:
  • Phone: 407-896-2323
  • Fax: 407-896-7760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number06001
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: