Provider Demographics
NPI:1841576113
Name:CO POLANCO, GUMI (MD)
Entity Type:Individual
Prefix:
First Name:GUMI
Middle Name:
Last Name:CO 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:PO BOX 800676
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-0676
Mailing Address - Country:US
Mailing Address - Phone:787-450-7185
Mailing Address - Fax:787-813-1512
Practice Address - Street 1:939 CALLE TRIGUERO
Practice Address - Street 2:COUNTRY CLUB
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-3339
Practice Address - Country:US
Practice Address - Phone:787-450-7185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11141208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice