=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235160979
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALICE MARIE POLICE M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1640 NEWPORT BLVD #200
-----------------------------------------------------
City | COSTA MESA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92627-3786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-351-2852
-----------------------------------------------------
Fax | 818-817-9835
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 12169
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92658-5054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-706-2134
-----------------------------------------------------
Fax | 949-706-6356
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | G44292
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 1111
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------