FORM MD 360 – NPI #1700557899
Otolaryngology

An otolaryngologist who specializes in the diagnosis and surgical treatment of head and neck conditions.

Health Care Provider Taxonomy Code for Otolaryngology

FORM MD 360 is an otolaryngologist located in MISSION VIEJO, CA. NPPES has assigned the NPI number 1700557899 to FORM MD 360 on September 28, 2021. It is a Type-2 NPI, indicating this NPI number is associated with an organization. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 207YX0905X from the Health Care Provider Taxonomy code set, which is classified as Otolaryngology, specializing in Otolaryngology/Facial Plastic Surgery

The NPI profile was previously updated about 3 years ago on Apr 26, 2023. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for FORM MD 360 below.

NPI Profile for
FORM MD 360

NPI Number
1700557899
Enumeration Date

(more than 4 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
FORM MD 360
Primary location
26691 PLAZA STE 200
MISSION VIEJO, CA 92691-8582
Phone: (949) 438-3644 Fax: (949) 998-2020
1 Other location(s):
4980 Barranca Pkwy Ste 201
Irvine, CA 92604-8653
Phone: (949) 485-2100
Fax: (949) 485-2161
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
TAYLOR POLLEI
CEO / OWNER
Phone: (949) 998-2020
Updated
Certification Date
Apr 26, 2023

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207YX0905X
- Otolaryngology / Otolaryngology/Facial Plastic Surgery (Primary)
2086S0122X
- Surgery / Plastic and Reconstructive Surgery
207YS0123X
- Otolaryngology / Facial Plastic Surgery

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.