1346080496 NPI number — DR. VICTOR EUSEBIO POLANCO SOTO JR. MD

Table of content: DR. VICTOR EUSEBIO POLANCO SOTO JR. MD (NPI 1346080496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346080496 NPI number — DR. VICTOR EUSEBIO POLANCO SOTO JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POLANCO SOTO
Provider First Name:
VICTOR
Provider Middle Name:
EUSEBIO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346080496
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2011
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AIBONITO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00705-2011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
939-278-6575
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE JOSE C VASQUEZ ESQ JULIO CINTRON
Provider Second Line Business Practice Location Address:
EDIF GUAYACAN SUITE 104
Provider Business Practice Location Address City Name:
AIBONITO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-735-1460
Provider Business Practice Location Address Fax Number:
787-735-1690
Provider Enumeration Date:
05/28/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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