Healthcare Provider Details

I. General information

NPI: 1194936922
Provider Name (Legal Business Name): PACIFIC BREAST CARE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 NEWPORT BLVD STE 200
COSTA MESA CA
92627-3786
US

IV. Provider business mailing address

1640 NEWPORT BLVD STE 200
COSTA MESA CA
92627-3786
US

V. Phone/Fax

Practice location:
  • Phone: 949-515-3544
  • Fax: 949-706-6356
Mailing address:
  • Phone: 949-515-3544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Internal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALICE M POLICE
Title or Position: PRESIDENT
Credential: MD
Phone: 949-515-3544