Form Md 360
LBN: Form Md 360
Form Md 360 is an health care organization with primary practice located at 26691 Plaza Ste 200 , Mission Viejo CA 92691-8582. The organization recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Facial Plastic Surgery, Allopathic & Osteopathic Physicians / Otolaryngology/Facial Plastic Surgery, Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery. Allopathic & Osteopathic Physicians / Otolaryngology/Facial Plastic Surgery is the primary health care specialty.
Form Md 360 can be contacted via phone (949) 438-3644, or through Pollei, Taylor via phone (949) 998-2020.
Contact Information
Primary practice address
26691 Plaza Ste 200
Mission Viejo CA 92691-8582
Phone: (949) 438-3644
Fax: (949) 998-2020
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Facial Plastic Surgery | 207YS0123X | ||
| Allopathic & Osteopathic Physicians / Otolaryngology/Facial Plastic Surgery | 207YX0905X | ||
| Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery | 2086S0122X |
Profile Details
| NPI number | 1700557899 |
|---|---|
| LBN Legal business name | Form Md 360 |
| DBA Doing business as | |
| Authorized official | Pollei, Taylor Doctor of Medicine (MD) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Sep 28th, 2021 |
| Last updated | Apr 26th, 2023 - about last year |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
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