Provider Demographics
NPI:1043048580
Name:POLANCO LUGO, ZULEIKA MARIE (CBHCM)
Entity type:Individual
Prefix:
First Name:ZULEIKA
Middle Name:MARIE
Last Name:POLANCO LUGO
Suffix:
Gender:F
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 CASTLE PINES LN APT 4125
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-3549
Mailing Address - Country:US
Mailing Address - Phone:407-820-5276
Mailing Address - Fax:
Practice Address - Street 1:3712 CASTLE PINES LN APT 4125
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-3549
Practice Address - Country:US
Practice Address - Phone:407-820-5276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM.0106653-P171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator