Provider Demographics
NPI:1831185271
Name:BERRY-POLANCO, JOSSEPP (MD)
Entity type:Individual
Prefix:
First Name:JOSSEPP
Middle Name:
Last Name:BERRY-POLANCO
Suffix:
Gender:M
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:BLOQUE 31 CALLE 31 # 8
Mailing Address - Street 2:VILLA ASTURIAS
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-5755
Mailing Address - Country:US
Mailing Address - Phone:787-529-5093
Mailing Address - Fax:787-768-8392
Practice Address - Street 1:AVE SANCHEZ OSORIO 2TR511
Practice Address - Street 2:VILLA FONTANA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-3226
Practice Address - Country:US
Practice Address - Phone:787-757-8065
Practice Address - Fax:787-768-8392
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7962208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
G16867Medicare UPIN
PR0029567Medicare ID - Type Unspecified