Provider Demographics
NPI:1346080496
Name:POLANCO SOTO, VICTOR EUSEBIO JR (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:EUSEBIO
Last Name:POLANCO SOTO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2011
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-2011
Mailing Address - Country:US
Mailing Address - Phone:939-278-6575
Mailing Address - Fax:
Practice Address - Street 1:CALLE JOSE C VASQUEZ ESQ JULIO CINTRON
Practice Address - Street 2:EDIF GUAYACAN SUITE 104
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-735-1460
Practice Address - Fax:787-735-1690
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program