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Individual
MR. MARIO POLANCO
Active
Individual
MR. MARIO POLANCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
B.S, DEGREE
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
PT 11680
CA
225100000X
Physical Therapist
Primary
11680
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-5607292
TAX ID#
CA
Enumeration date
02/28/2007
Last updated
12/22/2011
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