Provider Demographics
NPI:1972769172
Name:GARCIA-OSUNA POLANCO, ALEJANDRO (LAC)
Entity Type:Individual
Prefix:MR
First Name:ALEJANDRO
Middle Name:
Last Name:GARCIA-OSUNA POLANCO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:GARCIA-OSUNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:316 W ANN ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-1414
Mailing Address - Country:US
Mailing Address - Phone:646-902-1374
Mailing Address - Fax:
Practice Address - Street 1:316 W ANN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-1414
Practice Address - Country:US
Practice Address - Phone:646-902-1374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2023-01-10
Deactivation Date:2017-01-20
Deactivation Code:
Reactivation Date:2020-04-21
Provider Licenses
StateLicense IDTaxonomies
NY003592171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist