Provider Demographics
NPI:1508572983
Name:POLANCO SORIANO, REYNOL RAMON (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:REYNOL
Middle Name:RAMON
Last Name:POLANCO SORIANO
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20711 CACTUS LAKE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1666
Mailing Address - Country:US
Mailing Address - Phone:832-875-7716
Mailing Address - Fax:
Practice Address - Street 1:5724 CHIMNEY ROCK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-2713
Practice Address - Country:US
Practice Address - Phone:713-505-1077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1108762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily