GUSTAVO EMIL POLANCO HERNANDEZ (NPI# 1013558188) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013558188 |
| Entity Type | Individual |
| Full Name | GUSTAVO EMIL POLANCO HERNANDEZ |
| Credential | PA |
| Practice Address |
1611 Nw 12th Ave Miami FL 33136-1005 |
| Mailing Address |
8455 Nw 189th Ln Apt 1506 Hialeah FL 33015-7239 |
| Practice Telephone | 3055851111 |
| Mailing Telephone | 7863170766 |
| Enumeration Date | 2019-09-30 |
| Last Update Date | 2020-10-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
PA9112633 | FL | Allopathic & Osteopathic Physicians |
| Y | 207RC0200X |
Internal Medicine Specialization: Critical Care Medicine |
PA9112633 | FL | Allopathic & Osteopathic Physicians |
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
PA9112633 | FL | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1891 W Flagler St, Miami, FL 331351939 | 3056430550 |
| Street Address |
1611 NW 12TH AVE |
| City | MIAMI |
| State | FL |
| Zip Code | 33136-1005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740286251 | Karen Chitty | Emergency Medicine | 1611 Nw 12th Ave, Miami, FL 33136-1005 | 2005-06-21 |
| 1558968263 | Natalie Dinger | Nurse Practitioner | 1611 Nw 12th Ave, Miami, FL 33136-1096 | 2020-10-06 |
| 1306452057 | Ryan M Bukhari | Dentist | 1611 Nw 12th Ave, Miami, FL 33136-1096 | 2020-09-18 |
| 1467068155 | Hussien Touny | Student in an Organized Health Care Education/Training Program | 1611 Nw 12th Ave, Miami, FL 33136-1096 | 2020-09-18 |
| 1912512310 | Clementina Aurora Cabrera | Student in an Organized Health Care Education/Training Program | 1611 Nw 12th Ave, Miami, FL 33136-1005 | 2020-09-11 |
| 1184237265 | Kencya Toussaint | Nurse Practitioner | 1611 Nw 12th Ave, Miami, FL 33136-1096 | 2020-08-28 |
| 1568075976 | Manuel Molina | Student in an Organized Health Care Education/Training Program | 1611 Nw 12th Ave, Miami, FL 33136-1005 | 2020-08-25 |
| 1063025468 | Carlos Federico Moral Ortega | Student in an Organized Health Care Education/Training Program | 1611 Nw 12th Ave, Miami, FL 33136-1096 | 2020-08-25 |
| 1770195919 | Ezekiel Oluwasayo Ijaopo | Student in an Organized Health Care Education/Training Program | 1611 Nw 12th Ave, Miami, FL 33136-1005 | 2020-08-19 |
| 1568070258 | Virosh Dharmadasa | Student in an Organized Health Care Education/Training Program | 1611 Nw 12th Ave, Miami, FL 33136-1005 | 2020-07-19 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548875685 | Agustina Dirocco | Registered Nurse | 1611 Ne 12th Ave, Miami, FL 33136 | 2020-09-15 |
| 1093338451 | Krizia Amy Vinck | Clinical Neuropsychologist | 1150 Nw 14th St, Miami, Fl 33136, Miami, FL 33136 | 2020-05-20 |
| 1992327761 | Jorge Luis Cardenas Alvarez | Student in an Organized Health Care Education/Training Program | 1611 Nw 12 Avenue Central Room 600-d, Miami, FL 33136 | 2020-05-14 |
| 1104447036 | Denver Steven Pinto | Student in an Organized Health Care Education/Training Program | 1611 Nw 12 Avenue Jackson Memorial Hospital, West Wing 279 Emergency Radiology, Miami, FL 33136 | 2020-05-01 |
| 1992325724 | Dimple Kumar Chanamolu | Student in an Organized Health Care Education/Training Program | Deptarment of Urology University of Miama Miller School, Crb 1120 Nw 14th Street Suite 1551c, Miami, FL 33136 | 2020-04-22 |
| 1578100996 | Alex Aziz Al Khoury | Internal Medicine | 1120 Nw 14th St. Suite 1112, Miami, FL 33136 | 2019-12-04 |
| 1437708872 | Marie Jeanjean | Genetic Counselor, MS | 1501 Nw 10th Avenue, Brb 334 (m860), Miami, FL 33136 | 2019-09-09 |
| 1710543905 | Tal Friehmann | Student in an Organized Health Care Education/Training Program | Jackson Memorial Hospital, Breast Imaging Dep, 1611 Nw 12 Avenue, Miami, FL 33136 | 2019-05-14 |
| 1285297895 | Omar Munoz | Student in an Organized Health Care Education/Training Program | 1611 Nw 12th Av., Psychiatry Department, Miami, FL 33136 | 2019-04-18 |
| 1902369648 | Seyedeh Haleh Amirian | Student in an Organized Health Care Education/Training Program | 1611 12th Avenue, Holtz Buiding, East Tower, 2169, Miami, FL 33136 | 2019-04-10 |
| Find all providers in zip 33136 | ||||
| Taxonomy Code | 207RC0200X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Critical Care Medicine |
| An internist who diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891085171 | Vaughan Matthew Washco | Internal Medicine | Kendall Regional Medical Center, 11750 Sw 40th St, Miami, FL 33175 | 2011-04-07 |
| 1437448271 | Yoel Brito | Internal Medicine | 78 Sw 13th Ave Ste 202, Miami, FL 33135-2483 | 2011-04-01 |
| 1124202601 | Critical Care Emergency Medicine, P.a. | Internal Medicine | 2617 Lincoln Ave, Miami, FL 33133-4622 | 2007-12-20 |
| 1609927862 | Michael John Hernandez | Internal Medicine | 7000 Sw 97th Ave Ste 120, Miami, FL 33173-1474 | 2007-01-15 |
| 1154437028 | Carlos Ernesto Vaca | Internal Medicine | 8260 W Flagler St Ste 2h, Miami, FL 33144-2069 | 2006-08-22 |
| 1922036995 | Daniel H Kett | Internal Medicine | 1611 Nw 12th Ave # C455a, Jackson Memorial Hospital, Miami, FL 33136-1005 | 2006-06-29 |
| 1750377438 | Hugo Gonzalez | Internal Medicine | 3661 S Miami Ave Ste 308, Miami, FL 33133-4232 | 2005-09-27 |
| 1306354626 | South Florida Critical Care Services LLC | Internal Medicine | 8900 N Kendall Dr, Miami, FL 33176-2118 | 2018-01-22 |
| 1629430756 | Pedro Sevilla LLC | Internal Medicine | 7000 Sw 97th Ave Ste 120, Miami, FL 33173-1474 | 2016-03-28 |
| 1588059844 | Adhiraj Gosine | Internal Medicine | 1400 Nw 12th Ave, Miami, FL 33136-1003 | 2015-04-03 |
| Find all providers in MIAMI | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.