Provider Demographics
NPI:1487988374
Name:POLANCO, LUCIA A
Entity type:Individual
Prefix:
First Name:LUCIA
Middle Name:A
Last Name:POLANCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LUCIA
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SPECIAL EDUCATOR
Mailing Address - Street 1:4518 ROSS LANIER LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-2135
Mailing Address - Country:US
Mailing Address - Phone:347-399-9312
Mailing Address - Fax:
Practice Address - Street 1:4518 ROSS LANIER LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-2135
Practice Address - Country:US
Practice Address - Phone:347-399-9312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY389644031174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist