Individual
MRS. JESSICA POLANCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
712 S FERNWOOD ST, APT 25, WEST COVINA, CA 91791-2649
(626) 512-0054
Mailing address
712 S FERNWOOD ST, APT 25, WEST COVINA, CA 91791-2649
(626) 512-0054
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
686479
CA
Other
Enumeration date
02/16/2017
Last updated
02/16/2017
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