Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 35687-R | PR |
Y | 111NI0900X | Internist | 35687-R | PR |
N | 208D00000X | General Practice Physician | P101496 | NY |
NPI | 1023637493 |
---|---|
Provider Name | Dalvert H Polanco |
First Address | Bayamon, PR 00956-4816 |
Second Address | Bayamon, PR 00956-4816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2020 |
Last Update Date | 27/07/2021 |