Provider Demographics
NPI:1063828523
Name:PENA POLANCO, NATHALIE AURORA (MD)
Entity Type:Individual
Prefix:
First Name:NATHALIE
Middle Name:AURORA
Last Name:PENA POLANCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 8TH AVE SE STE 300
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-2106
Mailing Address - Country:US
Mailing Address - Phone:319-369-4542
Mailing Address - Fax:319-369-4543
Practice Address - Street 1:788 8TH AVE SE STE 300
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2106
Practice Address - Country:US
Practice Address - Phone:319-369-4542
Practice Address - Fax:319-369-4543
Is Sole Proprietor?:No
Enumeration Date:2014-07-05
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19794390200000X
PAMT222729390200000X
IAMD-49249207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program