Most Relevant Information
Provider Data
| NPI Number: | 1003355538 |
| Provider Name: | JESSICA POLANCO |
| Entity Type: | Individual |
| Taxonomy Code: | 164X00000X |
| Specialty: | Licensed Vocational Nurse |
| License Number: | 686479 |
Most Important Dates
| Enumeration Date: | 02/16/2017 |
| Last Updated: | 02/16/2017 |
Provider Practice Location
712 S FERNWOOD ST
APT 25
WEST COVINA
CA
917912649
Practice Location Phone/Fax
| Phone: | 6265120054 |
| Fax: |
Provider Mailing Location
712 S FERNWOOD ST
APT 25
WEST COVINA
CA
917912649
Provider Mailing Phone/Fax
| Phone: | 6265120054 |
| Fax: |