Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 4835 | PR |
NPI | 1679640619 |
---|---|
Provider Name | Eladio A Polanco |
First Address | San Juan, PR 00926-4821 |
Second Address | San Juan, PR 00926-4821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 08/07/2007 |