Provider Demographics
NPI:1730367210
Name:POLAREK, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:POLAREK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 TEXAS ST
Mailing Address - Street 2:SUITE 203 HOME START
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:91208
Mailing Address - Country:US
Mailing Address - Phone:619-692-0727
Mailing Address - Fax:619-692-0785
Practice Address - Street 1:1320 UNION PLAZA COURT
Practice Address - Street 2:O
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054
Practice Address - Country:US
Practice Address - Phone:760-439-7513
Practice Address - Fax:760-439-5625
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator