Provider Demographics
NPI:1255212254
Name:ALVEO POLANCO, BENJAMIN BASILIO (RD)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:BASILIO
Last Name:ALVEO POLANCO
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 NW 47TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-4044
Mailing Address - Country:US
Mailing Address - Phone:305-300-1723
Mailing Address - Fax:
Practice Address - Street 1:1821 NW 47TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-4044
Practice Address - Country:US
Practice Address - Phone:305-300-1723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND11203133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty