Provider Demographics
NPI:1235160979
Name:POLICE, ALICE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:MARIE
Last Name:POLICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12169
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-5054
Mailing Address - Country:US
Mailing Address - Phone:949-706-2134
Mailing Address - Fax:949-706-6356
Practice Address - Street 1:1640 NEWPORT BLVD
Practice Address - Street 2:#200
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3786
Practice Address - Country:US
Practice Address - Phone:866-351-2852
Practice Address - Fax:818-817-9835
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44292174400000X
SD1111208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA002686300Medicaid
CA00G442921OtherBLUE SHIELD
ID1124383Medicaid
ID1124383Medicaid
CAAP1115698OtherDEA NUMBER
CA002686300Medicaid
ID1124383Medicaid