Mario Polanco, B.S, DEGREE

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

11680 Issued in CA

Practice address

5301 Whittier Blvd
Atrium Suite
Los Angeles, CA 90022-4038

Phone

(323) 887-7458

Fax

(323) 887-8288

NPI assigned

Feb 28, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kaminsky Physical Therapy, Inc.

  • Physical Therapist
  • Los Angeles, CA
  • NPI 1417128125

  Single Specialty

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324512000000",
    "number": "1073640587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 45195",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900450191",
            "telephone_number": "323-887-7458",
            "fax_number": "323-887-8288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 WHITTIER BLVD",
            "address_2": "ATRIUM SUITE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900224038",
            "telephone_number": "323-887-7458",
            "fax_number": "323-887-8288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLANCO",
        "first_name": "MARIO",
        "name_prefix": "Mr.",
        "credential": "B.S, DEGREE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-28",
        "last_updated": "2011-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "PT 11680",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "11680",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID#",
            "identifier": "20-5607292",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Isabel Polanco
• Jennifer Polanco
• Joseph Nicolas Polanco, MD
• Joshua Polanco, BCBA
• Maria Luisa Polanco
• Sonia L Polanco
• Ray Anthony Poland, CMT
• Daniel Alexander Polansky
• Robin Polansky, MD, MPH
• Rachel T Polazzi, CRNA

• Physical Therapist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.