Provider Demographics
NPI:1275916637
Name:POLANCO, SARA (ND)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:POLANCO
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 NW EVERETT ST APT 202
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1939
Mailing Address - Country:US
Mailing Address - Phone:281-627-9405
Mailing Address - Fax:
Practice Address - Street 1:3701 SE BELMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4327
Practice Address - Country:US
Practice Address - Phone:281-627-9405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2099175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath