=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144204710
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA J POLANCO MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE POST 18 NORTE
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-834-0050
-----------------------------------------------------
Fax | 787-834-2104
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | J12 CALLE 8 URBANIZACION LA MONSERRATE
-----------------------------------------------------
City | HORMIGUEROS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00660-1627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-849-3472
-----------------------------------------------------
Fax | 787-849-3472
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 12471
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------