=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811891021
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YANITZMARIE POLANCO JORDAN MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2026
-----------------------------------------------------
Last Update Date | 10/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | G24 CALLE PRINCIPAL
-----------------------------------------------------
City | FAJARDO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00738-3774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-348-2717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19 CALLE CANELA
-----------------------------------------------------
City | CEIBA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00735-4010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-397-3828
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number | 9135
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------