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General NPI Number Information
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NPI Number | 1669653291
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Entity Type | Organization
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Legal Business Name | ROBERTO POLANCO MD PA
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 08/15/2011
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Provider Practice Location Address
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Address Line | 8501 SW 124TH AVE 102A
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City | MIAMI
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State | FL
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Zip | 33183-4627
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Country | US
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Telephone | 305-228-4422
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Fax | 305-596-4422
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Provider Business Mailing Address
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Address Line | PO BOX 655009
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City | MIAMI
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State | FL
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Zip | 33265-5009
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Country | US
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Telephone | 305-228-4422
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Fax | 305-596-4422
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Authorized Official
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Title or Position | MANAGER
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Name | MR. ONEL MONTALVO
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Credential | CPC,MA
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Telephone | 786-345-6991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME62015
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License Number State | FL
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