Provider Demographics
NPI:1285715326
Name:TOSADO POLANCO, JUAN A (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:A
Last Name:TOSADO POLANCO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:15408 CALLE FLAMBOYAN
Mailing Address - Street 2:URB. PASEOS DE JACARANDA
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-9621
Mailing Address - Country:US
Mailing Address - Phone:787-559-7119
Mailing Address - Fax:787-845-6958
Practice Address - Street 1:URB LA HACIENDA AVENIDA ALBIZU CAMPOS
Practice Address - Street 2:HOSPITAL MENONITA SUITE 209
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-866-5010
Practice Address - Fax:787-866-5010
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2019-01-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR13906207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0020854Medicare ID - Type Unspecified
PRH55737Medicare UPIN