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NPI Code Detail

MEDICARE: AIVLYS PEREZ POLANCO M.D.

MEDICARE: AIVLYS PEREZ POLANCO M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ND0900XDermatopathology PhysicianME130895FL
2207N00000XDermatology PhysicianME130895FL

General Provider Information

NPI Number : 1245307453
Entity Type Code : Individual
Provider Name (Legal Business Name) : AIVLYS PEREZ POLANCO M.D.
Provider Business Mailing Address
First Line : 151 SOUTHHALL LN
Second Line : SUITE 300
City : MAITLAND
State : FL
Zip : 32751-7176
Country : US
Telephone Number : 407-875-2080
Fax Number : 407-650-3544
Provider Business Practice Location Address
First Line : 8209 STATE ROAD 54
Second Line :
City : NEW PORT RICHEY
State : FL
Zip : 34655-3016
Country : US
Telephone Number : 727-569-1055
Fax Number : 727-569-1505
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2006
Last Update Date : 04/24/2017

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