Provider Demographics
NPI:1841223104
Name:DEMORIZI & POLANCO MDS PA
Entity Type:Organization
Organization Name:DEMORIZI & POLANCO MDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NESTOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEMORIZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-279-3878
Mailing Address - Street 1:8500 SW 92ND ST
Mailing Address - Street 2:STUIE 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7390
Mailing Address - Country:US
Mailing Address - Phone:305-279-3878
Mailing Address - Fax:786-235-0384
Practice Address - Street 1:8500 SW 92ND ST
Practice Address - Street 2:STUIE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7390
Practice Address - Country:US
Practice Address - Phone:305-279-3878
Practice Address - Fax:786-235-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363853-4207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24206Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER