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General NPI Number Information
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NPI Number | 1609649136
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Entity Type | Individual
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Provider Name | MITZANIA POLANCO DO
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Gender | Female
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 15470 NW 77TH CT
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City | MIAMI LAKES
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State | FL
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Zip | 33016-5823
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Country | US
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Telephone | 786-564-2439
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Fax |
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Provider Business Mailing Address
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Address Line | 6745 NW 169TH ST APT G
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City | HIALEAH
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State | FL
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Zip | 33015-4230
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Country | US
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Telephone | 786-564-2439
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | DO6785
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License Number State | FL
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