Form MD Plastic Surgery
Form MD Plastic Surgery is an Otolaryngology/Facial Plastic Surgery Physician in Mission Viejo, California. Registered with an NPI since 2020.
- In the registry since
- 2020
- Specialties on file
- 3
Practice location Address checks out
26691 Plz Ste 200Mission Viejo, CA 92691-8582
Phone: (949) 998-2020
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Otolaryngology/Facial Plastic Surgery Physician (primary) | Taxonomy 207YX0905X |
|---|---|
| Surgery Physician | Taxonomy 208600000X |
| Medical Specialty Clinic/Center | Taxonomy 261QM2500X |
Record details
| NPI number | 1164053104 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Taylor Pollei — Ceo/Provider · (949) 998-2020 |
| NPI enumerated | January 29, 2020 |
| Last updated in NPPES | April 26, 2023 |
| Certification date | April 26, 2023 |
| Mailing address | 26691 Plaza Ste 200, Mission Viejo, CA 92691-8582 |