Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 06003 | FL |
Y | 101YP1600X | Pastoral Counselor | 06003 | FL |
NPI | 1174777213 |
---|---|
Provider Name | Dr. Izilda M Polanco |
First Address | Orlando, FL 32809-3068 |
Second Address | Orlando, FL 32809-3068 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2008 |
Last Update Date | 14/11/2008 |