Provider Demographics
NPI:1033352810
Name:M.D. VIRGILIO POLONIO DE LUNA, C.S.P
Entity Type:Organization
Organization Name:M.D. VIRGILIO POLONIO DE LUNA, C.S.P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGIILIO
Authorized Official - Middle Name:ARISTIDY
Authorized Official - Last Name:POLONIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-836-3409
Mailing Address - Street 1:PO BOX 543
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-0543
Mailing Address - Country:US
Mailing Address - Phone:787-836-3409
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 385 KM 0.5
Practice Address - Street 2:BARRIO CUEVAS
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624-0543
Practice Address - Country:US
Practice Address - Phone:787-836-3409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10424208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty