Healthcare Provider Details

I. General information

NPI: 1831185271
Provider Name (Legal Business Name): JOSSEPP BERRY-POLANCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE SANCHEZ OSORIO 2TR511 VILLA FONTANA
CAROLINA PR
00983-3226
US

IV. Provider business mailing address

BLOQUE 31 CALLE 31 # 8 VILLA ASTURIAS
CAROLINA PR
00985-5755
US

V. Phone/Fax

Practice location:
  • Phone: 787-757-8065
  • Fax: 787-768-8392
Mailing address:
  • Phone: 787-529-5093
  • Fax: 787-768-8392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number7962
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: