Active NPI
Izilda M Polanco, PH.D
- Pastoral Counselor
- Orlando, FL
National Provider Identifier
1174777213
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pastoral Counselor
- License
- 06003
- Practice address
- 5205 S Orange Ave
Suite 203
Orlando, FL 32809-3068 - Phone
- (407) 240-7003
- Fax
- (407) 240-7003
- NPI assigned
- Nov 14, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 06003 | FL | |
| Pastoral Counselor | 101YP1600X | 06003 | FL | Primary |
Addresses
Primary practice location
5205 S Orange Ave
Suite 203
Orlando, FL 32809-3068
Mailing address
5205 S Orange Ave
Suite 203
Orlando, FL 32809-3068
Phone (407) 240-7003
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06003 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1226620800000",
"number": "1174777213",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5205 S ORANGE AVE",
"address_2": "SUITE 203",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328093068",
"telephone_number": "407-240-7003",
"fax_number": "407-240-7003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5205 S ORANGE AVE",
"address_2": "SUITE 203",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328093068",
"telephone_number": "407-240-7003",
"fax_number": "407-240-7003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLANCO",
"first_name": "IZILDA",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-11-14",
"last_updated": "2008-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "06003",
"primary": false
},
{
"code": "101YP1600X",
"taxonomy_group": "",
"desc": "Counselor, Pastoral",
"state": "FL",
"license": "06003",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.