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NPI Code Detail

MEDICARE: TAJA POLANCO ASW

MEDICARE:   TAJA  POLANCO  ASW
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
1101Y00000XCounselor106233CA

General Provider Information

NPI Number : 1467927921
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAJA POLANCO ASW
Provider Business Mailing Address
First Line : PO BOX 151
Second Line :
City : ROSEVILLE
State : CA
Zip : 95678-0151
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4250 AUBURN BLVD
Second Line :
City : SACRAMENTO
State : CA
Zip : 95841-4164
Country : US
Telephone Number : 916-489-3336
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2018
Last Update Date : 01/10/2022

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Directions to “ TAJA POLANCO ASW” Practice Location

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