# FORM MD 360

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700557899
- **Authorized official:** TAYLOR POLLEI MD (CEO / OWNER)
- **Authorized official phone:** (949) 998-2020

## Contact information

- **Practice address:** 26691 PLAZA STE 200, MISSION VIEJO, CA 92691-8582
- **Practice address phone:** (949) 438-3644
- **Practice address fax:** (949) 998-2020
- **Mailing address:** 26691 PLAZA STE 200, MISSION VIEJO, CA 92691-8582
- **Mailing address phone:** (949) 998-2020
- **Mailing address fax:** (949) 998-2021

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YS0123X | Facial Plastic Surgery Physician | — | NULL | — |
| 207YS0123X | Facial Plastic Surgery Physician | — | — | — |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | — | NULL | Yes |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | — | — | Yes |
| 2086S0122X | Plastic and Reconstructive Surgery Physician | — | NULL | — |
| 2086S0122X | Plastic and Reconstructive Surgery Physician | — | — | — |

## Other

- **Enumeration date:** 09/28/2021
- **Last updated:** 04/26/2023