Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC28722 | CA |
NPI | 1811922594 |
---|---|
Provider Name | Dr. Thomas Christopher Polucki |
First Address | Newhall, CA 91321-5760 |
Second Address | Newhall, CA 91321-2409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 27/11/2019 |