Individual
JULIO POLANCO TAVERAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
180 BROAD ST APT 1241, STAMFORD, CT 06901-5004
(845) 200-8233
Mailing address
180 BROAD ST APT 1241, STAMFORD, CT 06901-5004
(845) 200-8233
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
340160
NY
Other
Enumeration date
08/08/2023
Last updated
08/08/2023
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