Provider Demographics
NPI:1194936922
Name:PACIFIC BREAST CARE MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:PACIFIC BREAST CARE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:POLICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-515-3544
Mailing Address - Street 1:1640 NEWPORT BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3786
Mailing Address - Country:US
Mailing Address - Phone:949-515-3544
Mailing Address - Fax:
Practice Address - Street 1:1640 NEWPORT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3786
Practice Address - Country:US
Practice Address - Phone:949-515-3544
Practice Address - Fax:949-706-6356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No207RM1200XAllopathic & Osteopathic PhysiciansInternal MedicineMagnetic Resonance Imaging (MRI)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2944453OtherARTICLES OF INCORPORATION
CAFNP35928OtherMEDICAL LICENSE FIC NAME
CA=========OtherTAX ID NUMBER
CA=========OtherTAX ID NUMBER